Goodbyes with the preschool

       I got to the clinic a few minutes early this morning, which meant I was able to spend some time with our preschoolers as they gathered in the yard for singing and dancing. The teachers all know I'm leaving tomorrow and wanted to take some pictures, so we huddled together and started clicking away.

It took some coordinating

And some negotiating

But we finally got it. Mostly.

I'm going to miss these precious faces when I'm in the States!

Out with a bang!

      This will be my last week in Haiti for 2014 and I'm going out in a rush of activity. The last several weeks have been a flurry of training for my staff as I prepare to leave the clinic in their hands while I am gone. We have been practicing communication and teamwork as we all figure out how to fit together. I have been training them on our computer charting system and inventory practices, as well as our protocols and individualized patient education expectations. They have done a wonderful job asking questions, practicing flexibility and absorbing an enormous amount of new information in a short amount of time.
       Since I am leaving Saturday, this week is our trial run where my staff begins to operate without me. I wanted them to have a few days where they were working without me hovering, but where I was available for any questions or concerns that arose. Today was our first day and I was pleased with the results. The MOHI clinic has become my baby, but I feel optimistic about leaving it in their capable hands.
      We also have a team from Bless Back Worldwide this week doing well child checks on all of the nearly 800 children in our schools. Somehow a rumor got started among the elementary school that the team is here to give them all shots. Things went more smoothly after we clarified that this was not the case. Along with head to toe check ups and deworming, the team is teaching our students about proper sanitation and the importance of keeping their living environments clean. After the teaching and check ups, each student is receiving a water bottle to carry with them and encourage them to increase their hydration during the day. Hurray hydration!
      Will you join with me in prayer over the next few days? Will you pray for the Bless Back team as they continue to work incredibly hard to see all of our kids? Will you also be praying for my staff in this time of transition- that any questions would be answered, any snafus would be untangled, and any anxiety (mine, for instance) would be soothed? Thank you!

Baptism

      We had a baptismal service yesterday after church. Church members came by foot, by car and by motorcycle. They gathered at the beach behind our guesthouse property to pray, sing and bear witness to these holy moments. The baptismal candidates, many of whom were from a local orphanage with an extensive history with MOHI, came outfitted in white.
     After individual prayer and guidance, the candidates were immersed. In pairs they rose up out of the water, smiles radiant. As they broke through the surface, droplets of water glistened in the sun and I stood in awe at the new life happening in front of me. Waves threatened to knock one girl down, until she was steadied by one of the baptizing pastors who also acts as a father figure in her life. When they returned to shore, the newly baptized were welcomed with towels and smiles into the arms of their church community.  Baptisms always make me cry, but this one was particularly beautiful.

Two years in

       In a little over two weeks, I will be wrapping up my second year living in Haiti. Being me, I have feelings about this (having feelings is one of the things I'm best at doing). Two years ago when I was getting ready to embark on this adventure, I thought that if I could just check all the boxes, I could be prepared for what was coming. I think a part of me knew there was no way to really prepare for what was in store, but I tried. I read books on missions and development and what it means to do those things well. I listened to podcasts and sermons and prayed my little heart out.
       Then I got here, and it's been more than I could have dreamed. If you had told me at the end of October 2012 that in under two years, I would be running a clinic (with a staff!), I would have laughed you off. Yes, I dreamed of those things, but I didn't dare hope that my dreams could really happen. I didn't dare hope to find a mission with like minded people I could respect, work with, and when necessary submit to. I didn't dare hope that educational programs could be started. I definitely didn't dare hope that the first nurse we hired would be dedicated to learning every possible thing she could in order to better her professional practice.
       I was reflecting this morning on how deeply grateful I am for the last two years. They have been hard, enormously hard most days, but they have also been incredibly rich and beautiful. I have a group of coworkers I can laugh with. I have learned to make jokes in a second language. A huge chunk of my heart is now walking around with a couple of half-grown, moody teenage boys. I have been challenged, stretched and grown in a myriad of ways. My thinking on the kingdom of God and faith in general is more nuanced than before.
     As I start dreaming for year three, I am so incredibly grateful for the time I have spent here and cannot wait to see what 2015 holds. To all of you, who through prayer, finances, Skype calls and emails have made this thing happen, thank you for your support. As this communal culture continues to teach me, I couldn't do it without you!

Our new staff

The Doctors Lavaud, a married couple, split the work week between them as they hold down other positions as well. I appreciate their gentleness and patience in teaching patients.

Nurse Ruth consistently seeks out opportunities to learn new things in the clinic and jumps right in to help with any needed task.

 

Introducing our new MOHI clinic staff:

         Having a staff meant I got to spend some one on one time with this chickadee yesterday, convincing her to take her worm medicine. Yes that is a lollipop in my hand. Like Mary Poppins, I believe a spoonful of sugar helps the medicine go down.

      In unrelated housekeeping news, I fly to the States in a little under three weeks and will be there until early January. I'll be traipsing around Florida. Let me know if you want to get together!

Enough

     Last Sunday I listened to a sermon about how the Lord uses us in our weakness, how coming to the end of ourselves can be a redemptive thing when it allows the Lord to work in our lives. After listening to it, I basically thought to myself "well, that's nice" and filed it away for later.
      Later came faster than expected. In the space of a week I have gone from running the MOHI clinic on my own, to having a staff. Suddenly tasks are getting accomplished faster and I am having to learn to manage personalities in a culture that is not my own, in a language I still wrestle with. More than twice I have wondered when everyone was going to catch on that I am not enough for the task at hand. Not smart enough. Not strong enough. Not culturally sensitive enough. Not experienced enough. Not tall enough. Not enough.
    The thing is, all of those things are true. I am not enough for the task at hand, for the dreams that are being spun for the MOHI clinic. Left solely to my own knowledge and experience, I will make an utter mess of this thing that is so precious to me. Which I why I have been enormously grateful not to have been left to my own devices this week. There has been the grace of an international network of experienced health professionals to refer to for the program building. There have been people with more experience and insight into this culture than I have to talk me through laying a foundation of professionalism and respect for my new employees.
     More than anything, there has been the grace of me, on my knees before my God, begging for mercy as I negotiate these changes, begging for the grace to know how to proceed. Would you continue to join me in prayer for the MOHI clinic and the major and exciting changes we are making? Pray that we would work in unity for the good of our friends and neighbors, that we would learn to communicate and fit together well, that we would glorify the Lord in our thoughts and actions. Thank you.

Welcome Dokte!

     After a roller coaster week of decision making and interviews, I am terribly excited to report that we have hired a doctor for the MOHI clinic. Dr. Miche Lavaud was born in Haiti and educated in Haiti and the Dominican Republic as a physician and an ultrasoud technician. He has several years experience working in both countries in hospital settings and speaks Kreyol, English, French and Spanish.
    Part of the vision of the MOHI clinic involves working respectfully within existing health systems in Haiti. Among the assets that Dr. Lavaud brings to the table is several years experience working in Grand Goave's local hospital. Dr. Lavaud's experience and connections open doors for our clinic to expand our level of care and assist our patients in further fulfilling their healthcare needs. Today was his first day on the job and he is already setting up personal appointments with patients to help them get needed surgeries. Welcome to the team Dr. Lavaud!

Update from the clinic

       We spent this week dreaming for the MOHI clinic, weighing options and weighing next steps. We look forward to the days of a fully Haitian staffed clinic and strong community health programs and have been looking at how to implement those goals. In looking at our options, we have decided that next steps for the clinic include hiring a Haitian physician and nurse to work alongside us.
       There are several reasons we are excited about these next steps. For one thing, having Haitian staff helps affirm the dignity of the patients we serve. Haitian healthcare workers are already familiar with language and cultural nuances and needs, and can bring a depth of insight into patient care that would take me, as a foreigner, years to match. The other exciting point about increasing staff is that it frees me up to pursue building up our community heath programs. Having Haitian medical professionals gives me more time to pursue programs, and more resources to partner with as we work together to develop health related classes and try to develop a more community based role for the clinic.
          Hiring a staff takes money. I don't love asking for money on this blog (or really at all), but for this I will. We are developing a physician sponsorship program where people could donate monthly towards the cost of paying our doctor. If that is something you would be interested on, please contact me. Beyond that, will you continue to join me in prayer for the MOHI clinic in this decision making and transition time? Thank you!

Sometimes

      I have written before about how I am learning to lament this year, gaining practice in grief. Sometimes (most times) that grieving comes from being here. It comes from the patient who refused to be compliant on his TB medication and died, despite all our efforts at intervention and education. It comes from the woman who comes to the clinic with a massive breast mass and almost no treatment options. It comes from the daily hurts of systemic injustice. I counted the cost of this kind of grief when I came  to Haiti. I expected it. I prepared for it.
     It turns out there is another kind of grief, the grief of not being there. This grief crashes down when the people I love more than almost anything are wading through hurt and our contact is limited to Skype, Gmail or Facebook. Modern technology is an incredible grace in allowing me to remain connected with loved ones in the States, but it does not replace sitting on the couch and sharing the hurt with them. I am nothing if not a nurturer and I was not, am not prepared for the grief of not being present. This grief leaves my heart small and shivering, to borrow a phrase from one of my favorite novels. My closest friend is walking through heaps of pain this year and I hate, hate, hate being so far away. I would give almost anything to be able to sit with her in her tears tonight. Since I can't be there with her in person, will you join me in praying for her as she hurts?

Prayer Request

     I have had a cold this week, which has left my head floating somewhere above my neck, barely tethered. This makes stringing sentences together in English difficult. Let's not even talk about my Kreyol language skills the last few days.
     As I have mentioned before, we are looking into major changes for the MOHI clinic. Things have been absurdly busy in the clinic for months and we are in the process of trying to figure out what our next steps should look like. We are looking at how to wisely implement opportunities available to us in the best interest of our patients. Join with us in prayers for wisdom and guidance as we figure out what the next few months will look like? Thanks friends!

Oral Rehydration Corner

                Yesterday's clinic experience was a veritable parade of mamas making wonderful choices for their children.We had mamas bringing their kids in for follow up appointments (more a of a rarity than we would like), mamas advocating for their babies' needs and mamas working with us to help rehydrate their sick toddlers. I was fairly dancing by the time clinic ended, a rarity for Monday.

One of the things I see fairly often in the clinic is children under five years old with diarrhea, a major worldwide killer. We have implemented a set of protocols for treating these children that follow WHO recommendations. Part of these procedures involves keeping children with some dehydration in the clinic for a couple of hours, to orally rehydrate them, and assess whether they are stable to go home. This procedure gives us (hopefully) a four hour window with these children and their caretakers, a great opportunity to chat and teach. At least that's the theory. In practice it is difficult to convince caretakers to stay for the entire time and I am often left giving instructions for home care, a much less preferred option. We had a little girl in the clinic yesterday who fit the criteria for some dehydration and I asked her mama to stay with us for a bit, so we could give her daughter the fluids she needed. The mama, to my very great delight, agreed.

 In an effort to keep little ones from going stir crazy in the clinic, and to encourage the caretakers to stay for rehydration therapy, I keep some educational activities around for them. Yesterday I shared a coloring book and a book with the alphabet in it with the mom and her daughter. After explaining what I needed from the mom, as far as giving her daughter frequent sips of fluid, I left them to themselves to see my next patient. Within a few minutes, I heard the mom singing the ABCs with her daughter and her daughter trying to sing along. This continued off and on for the better part of an hour, interspersed with drink breaks, where the mom managed to turn getting the needed fluid to her child into a game that keep the little girl drinking plenty and often, exactly as we like it for dehydrated toddlers.. 

I'm not sure if I can express strongly enough how beautiful the whole thing was to watch. This mom who had been desperately worried about her daughter, singing and playing with her just a few minutes later.The little girl who came to the clinic droopy and left with a bounce in her step. Some of their friends who were in the clinic line, who celebrated with the mom over her daughter starting to look better. I was left marveling again at the beauty and strength in this incredible country.

School Nurse: Year Two

        As I mentioned in previous posts, school started back up at MOHI about a month ago, which meant I resumed my duties as school nurse. I have written before about some of what it looks like to act in this role, but things have changed a bit in how I relate to the kids as we start our second year together. Last year was a time of getting acquainted with one another. This year, we are working off of that foundation, which can be a lot of fun.
      Working off of that foundation means there's a first grader who stops on her way to lunch to fling her arms around my waist and proudly announce that she drinks lots of water. (I am forever telling the students that drinking more water will help heal near any ailment they come to me with.) It means there are twin preschoolers who jump up and hug me every time they see me. It means the teacher for our youngest preschool class brings a group by the clinic on a tour of the school, to introduce me and tell them they do not have to be afraid of seeing me
       It means welcoming teachers back, and rejoicing to see how they work with their students. It means birthday crowns in the preschool and singing and dancing in the yard when I arrive to start clinic. It means clinic consultations happen at a slightly higher volume because of the lectures going on in classrooms. It means a line of kids in the clinic in the afternoons, coloring and reading books and talking to me about what they see in the books. It means discussions on hand washing and trash disposal and tooth brushing. It means smiles and cheers and bustling activity. It means a continual influx of new reasons to fall in love with this country.

Recounting Charlotte

                Last week was a whirlwind of meetings and family time and all kinds of grace.  I flew to Florida a week ago Saturday and to Charlotte last Monday. While in Charlotte, I met with Lex and Renee and various people from Bless Back International to discuss clinic matters, or as as I like to call it, the state of the union. 

                The meetings in Charlotte mostly involved discussing next steps for the MOHI clinic. It was a time for spinning dreams and what-ifs and what-nexts, for weighing opportunities and finding ways to improve and expand clinic services. More on those things as they develop. Usually when I am with the people from Bless Back, it is in Haiti and we are running full speed ahead in the clinic, so the chance to enjoy one another as people was welcome.

                The second major blessing of last week was seeing the Edmes. Well, most of the Edmes. They have been State-side since the beginning of August, making this the longest stretch apart since I came back in January. One of the more bittersweet aspects of them being gone has been how much I have missed spending time with them. We work well together as a group, but in a tremendous grace for a group who spends as much time together as we do, we also enjoy one another's company. I mean, I am assuming they enjoy mine. I certainly enjoy theirs. Last week we moved the party to Charlotte and laughed over every ridiculous thing we could think of.

               Speaking of laughter, I sandwiched the Charlotte trip with weekends at home with my family and best friend. When we are together, I laugh until a cry, until my sides ache and I cannot breathe. The grace of being surrounded by people who know some of the deepest, rawest parts of me and love me anyway is almost more than I can take in. When I am home with them, I am absolutely saturated with love.
               

                

Charlotte

       I head to the States tomorrow for a quick trip to Charlotte by way of South Florida. I will be meeting with the Edmes, and people from Bless Back International, MOHI's main medical partner. I checked the weather for Charlotte, and apparently it's supposed to be in the 50s at night. So I will most likely freeze death in the next week. Assuming that doesn't happen, I am beyond excited for a couple of days with family, friends and hot showers. My internet connection took the week off without my approval. Now that it is fixed, I am madly scrambling to get things caught up to fly out tomorrow, so I will leave you with this picture of one of our preschoolers today.

Learning to live here

"If you have come here to help me, you are wasting our time.

But if you have come because your liberation is bound up with mine, then let us work together."

Aboriginal Activists group, Queensland, 1972

 

            I stumbled on this quote on a global health forum this week and it resonated deeply within me. I (naturally) spend a lot of time thinking about cross-cultural interactions and what it looks like to live well in a culture I was not born into. When I look at Haiti, I see a lot of damage done by well-meaning foreigners. We look at this country and decide it is broken, and since our way of living in our country works for us, we decide that this country needs to live like us. Consciously or subconsciously we assume that our way is the only right way to live. We miss (or misunderstand) the complex and wildly different history of this country, and more importantly we don’t see the beauty in how this culture functions. We don’t speak the language, or we don’t speak it well. We misinterpret interactions and we don’t listen or learn much. Instead, we impose.

                        I think there are two main ways of interacting with a foreign culture. One is the way mentioned above, bringing in the things that work in our culture and assuming if those things were just done here, this culture would be “fixed.” Few of us would phrase it so baldly, but our actions betray our underlying assumptions. This is the way of belittling our brothers and sisters in words and in actions, in snide jokes and muttered asides. We see the material comfort of our country and assume that our way is the only way. We see different as wrong, and in our attitudes and words belittle differences in others’ ways of doing things. This does so much damage to both sides. So much damage. It harms the people we are supposed to be working with, telling them in so many words, that they are less, and it harms us as pride and superiority, attitudes completely contrary to the Gospel, root themselves even more deeply in our lives.

            There is a second way. This way involves humility and listening and learning to see the value in the way another culture operates. One of the things I love about working with MOHI is talking to Renee. Renee has an incredible capacity to see the richness in Haitian culture.She sees beauty and strength rather than only weakness, and she celebrates what she sees. Moreover, she celebrates with me as I learn to see these things too. So many times I have come into her office to talk about something I witnessed, trying to process my thoughts. Over and over she has helped me see how the people of Haiti bring something unique and valuable and necessary to the kingdom of God. I believe that this is the way of peacemaking, the way that brings the healing that all of us, American and Haitian desperately need.

            Writing this post has been a bit of a “get the plank out of your own eye first” experience for me. I am leagues from getting this right. I spent the last week beyond frustrated with the way some systems work in this country, and to my shame mouthed off to my Haitian friends about it more than once. By the grace of God, I am learning to see. Grace opens my eyes to my complicity in the brokenness around me, and grace opens my eyes to the kingdom of God- a bigger, richer, more beautiful thing than I could have imagined on my own.

Babies

      If you know me, you know I love kids, especially babies, especially toddlers. I love talking to kids, I love holding other people's babies, I love watching them play and learn to walk and be fascinated by the world around them. Unfortunately,  babies and toddlers in the MOHI clinic do not always feel the same way about me.
      Sometimes, like this morning, things don't go so well. Someone tries to bite me for taking his temperature. Someone else pees on the floor. A third child screams so loud throughout their consultation that I can't hear anything their caregiver tells me. Or some combination of the above. Days like those endear my adult patients to me.
      One other days, things go beautifully. There was a twenty pound eight month old who grinned toothlessly at me through her entire visit last week, giggling sporadically when I listened to her lungs and tummy. The little one pictured below did not cry once during her visit, and showed weight and development gains since her last visit.

    Those are my favorite clinic days.

Back to School

It was a busy first week back for the students and teachers at our Thozin campus!

Happenings

Some tidbits from the last few days:

• I had a couple American women over for coffee on Saturday. In an effort to be more Haitian in my approach to hospitality, I baked. (Note: I hate baking.) This happened:  

        Martha Stewart, I am not.

• It was annual conference time for our sister church in the mountains, so I got to experience church in St. Etienne for the first time in a year. I do like it up there.
• Today was the first day back to school for our students. In a remarkable event for Haiti, and a testament to the hard work of our school staff, we actually started the school year on time. 
• Thanks to the above mentioned note, there was a troop of sweet and smiling faces greeting me this morning when I arrived to start clinic. I missed those babies over the summer.
• Our patient with the chronic leg ulcers was two weeks healed and counting. I was all set to add that to the list of rejoicings in this post when he walked in the clinic with one of his leg wounds reopening. Although this is the expected course of the disease, it's still a disappointment. Feel free to keep us in your prayers.
• We had a 13 pound three month old in clinic today. He had a double chin and rolls on his thighs. That was a good way to make Monday morning a little more welcome.

Friendship

"It is a wonderful thing and a strengthening of faith that two souls differing from each other in place, nationality, language, obedience and age should have been thus led into a delightful friendship" 

C.S. Lewis 

   Cross-cultural friendships are hard. Period. Two people coming from completely different, sometimes opposing ways of viewing the world affects everything from food choices to laundry. It is especially difficult when the people don't speak the same native language, or there are major power differentials between them. I believe these relationships are possible, if people are willing to do the necessary work. I also believe these relationships need to be walked out carefully, prayerfully, especially on the part of the person coming in with the power balance on their side.

        Ironically since I am an introvert, relationships are the lifeblood of who I am, and an integral part of my time in Haiti. This culture does community in a way that my individualistic, American mind finds hard to fathom, but I am learning. I am learning to allow the people around me into my joys and my sorrows, my triumphs and my disappointments

      With the Edmes in the States, I have been the only blan around MOHI. When not busy bemoaning the states of international affairs, I have been incredibly blessed by the people I work with and their care for me. One of our translators comes into the clinic every morning to make sure I am okay. One of my coworkers shares his food with me when he knows his wife made my favorites, and runs interference for pushy patients. The woman who runs our guesthouse listens patiently as I stumble through relating clinic stories every day. The groundskeepers and overnight watchman make a point of checking on me every night before they settle down for the evening. This time with these friends and coworkers has been brimming with opportunities for me to experience the truth of the above C.S. Lewis quote.

Blessed are the peacemakers

     I repeat this phrase to myself all the time. Sometimes as a promise, sometimes (when I'm frustrated) as more of an epithet. I have been meditating on what it means to live as a peacemaker more or less since moving to Haiti. I believe there are ways in my day to day life to practice peace, and I am trying to learn to find them. I definitely don't have it down, even as I write this, I have been wrestling down a snippy tongue all day. That wrestling has felt harder in the last few weeks with the incredible influx of violence streaming in, trying to stifle my words and my hope.

    I long for peace in the world around me, for the promises in Isaiah to be fulfilled. I want to see swords made into plowshares and spears into pruning hooks. Lately that hope has felt farther away every time I catch up on world events, or events in my home country. One of my favorite bloggers described it as a summer of sorrow. So I wrestle with the reality in front of me. How do I push for peace for Iraq? For Gaza? How do I turn swords into plowshares in the reality of racism in my home country? How do I live a Resurrection saturated life when Ebola is ravaging West Africa? I don't have answers, although I'm taking suggestions.

Weighing In

     Part of the protocol for clinic visits for children under five is a risk screening for malnutrition. There are different levels of malnutrition, and once a child hits the more severe stages stages, their care becomes specialized and outside of the level of care we can provide. So we try to catch at-risk kids before they get to those severe stages. Through education, deworming, food supplementation and monthly (or biweekly for younger infants) weigh-ins we try to keep  these kids from more severe illness.
        Rounding off our week of healthy twins was a visit from a couple of little girls I've been following closely since last fall. They have a dedicated mama who makes every appointment and finds creative ways to help her daughters get the nutrition they need. Thanks in no small part to her care, these girls have gained enough weight to graduate out of the malnutrition danger zone. I rejoice at how these babies flourishing now. They run and play and laugh like the kids they are, getting ever stronger and healthier. Seeing them was a perfect bookend for the work week.
   

How to make a nurse's day

     I have written before about how, week to week, it feels like different conditions come through the clinic in waves. One week it is hypertension, the next week it is heartburn. Apparently, this is our week for healthy infant twins, or as I'm starting to call it, my favorite week yet! 

     Yesterday we had a set of five week old twins, a boy and a girl. When I met Jhomline and Jhomley two weeks ago, I was concerned about Jhomley both because he was quite a bit smaller than his sister and because being newborn twins in Haiti is no easy task. Yesterday at their weigh in, each baby had gained at least a kilogram. There are few better ways to start the clinic week, than with babies gaining weight, especially when one of those babies snuggles when you pick him up. Ask me how I know.

     Then, this morning in clinic we had ten month old twin girls who weighed in at about 19 pounds each. I held both of them at once, and nearly threw my back out! Both of these girls were healthy overall, with only minor ailments, making their visit that much sweeter.

(Neither Mandina nor Mandana was really feeling the whole "let's take a picture" thing.)

     Completing my delight with today was a pair of healed ankles. I wrote last year about the young man being treated in our clinic for chronic leg ulcers and about our efforts to find a treatment regimen that would work for him. Last fall we found a regimen that seemed to be effective, and we have been using it ever since. His right ankle wound closed up in March (and has stayed that way!). His left ankle has taken a longer, but is now closed up as well. There is nothing like the sight of granulated skin tissue to put a grin on my face and a bounce in my step.

     Weeks like the last one, overwhelmed by grief and the brokenness of the world make these joys even more poignant. Will you join me in prayers of gratitude for the last couple of days in the MOHI clinic?

Haunts of Violence

"Have regard for your covenant,

because haunts of violence fill the dark places of the land."

Psalm 74:20

       There is another, deeper reason I have been wrestling writer's block lately. Ukraine. Iraq. Israel. Missouri. The last few weeks has been bloodier than Ancient Rome's Coliseum. Every time I check the news I find more reasons to grieve and fewer words to talk (or write) about them.
      I wrote a couple of months ago about how I have been learning about lament. I don't believe in coincidence, and I don't believe it is a mistake that I have been reading Jeremiah, Lamentations and some writings from Walter Brueggeman, all writers who feel deeply the brokenness of the world around them. My heart yearns for justice and healing, mourning the damage we do one another and the land around us. I find myself on my knees crying out with the Psalmist for my God to remember His covenant and See the violence all around.

Routine

      I have fallen into a routine (or alternatively, a rut) recently. I get up work-out, eat breakfast, yell at the cats for trying to steal my breakfast, go to clinic, and see patients. I spend the afternoons trying to balance catching up on clinic tasks with the demands of the kids that come in to hang out. Then I go home, contemplate cleaning my room, pick up a book instead, read for awhile and go to sleep. The next day, I get up and do it again. Saturdays are catch up on everything that didn't get done this week days, and Sundays are church. In between it all I do a lot of sweating.
    I do not thrive on routine. At all. I like change, adventure and not really being able to predict what tomorrow will look like. The routine leaves me feeling like I don't have anything to blog about. The days blur together and I end up with a series of blog posts that are mostly pictures.
     In my numbness at my routine, I can lose sight of the grace filled moments in my day. Ample time laughing with my gaggle of half grown boys. Favorite foods from the coworker whose gift is hospitality and who knows how much I love his wife's coking. The steady stream of people who have been checking on me with the Edmes out of the country. The taken for granted grace of medicines working like I want them to for some of my sicker patients. My life is filled with blessings, and in my day to day life I don't want to miss it. I don't want to grow familiar with the blessing and miss the beauty.

This week in pictures

      I have writer's block again this week, and cannot seem to get my thoughts into words. So, here are some pictures from clinic.

This is Mariange. She handles the morning clinic sign in process.

Mobile clinic in St. Etienne.

My work space.

                                 

Waiting in line to be seen.

This little guy was less than enthused about getting his temperature taken.

Things got a little better for him later in the morning, after a lollipop.

Good Morning Grand Goave!

This was the view from my house this morning. This is also a compelling reason to get up early at my house.

Women's Conference part 2

       The rest of this week with filled with women's conference activities. Wednesday we had had teaching seminars focused on younger women and their health needs, Thursday we a time with the older women of our community, and Friday was a day for new moms. Along with classes on everything from breastfeeding to menopause, all of the attendees got a chance to see our practitioners, make a craft and spend some time in a relaxation room getting their nails done and being pampered. It was a flurry of activity, but it was a beautiful flurry.

Women's Conference

     After months of planning and hours of preparation our first ever women's health fair began yesterday with our partner organization, Bless Back International. For me, this time has been saturated in joy. We kicked off the conference by worshiping with the nearly 300 attendees. Sap that I am, I dissolved into tears, overwhelmed by the beauty, and had to hide in Renee's office so I could pull myself together. 

     We have already had a series of teaching seminars on everything from healthy food choices, to choking to fetal development, and are only two days in! Women have had the opportunity to make crafts, see our medical providers and enjoy a beauty room that includes manicures and makeup application. It has been a delight to watch these women I love be honored, respected and pampered, to see their excitement and overhear their discussions about the different things they are learning and experiencing. 

     One of the most precious moments was watching a pregnant woman see her baby on ultrasound this afternoon. The joy on her face brought tears to my eyes (again). Several pregnant have women come through the clinic in the past, hoping for an ultrasound, only to be disappointed that we are unable to offer that service. The opportunity to rectify that this week has been a highlight. Will you join us in prayer for the next few days, that we would continue to honor and serve our sisters, and savor our time together? Thank you!

Crammed

"Earth's crammed with heaven,

And every common bush afire with God;

But only he who sees, takes off his shoes,

 

The rest sit round it and pluck blackberries,

And daub their natural faces unaware"

Excerpted from Aurora Leigh by Elizabeth Barrett Browning

Thanks to Nora Walker for the St. Etienne pics!

Overflowing

      We have been brimming with things to rejoice about at MOHI in the last few days. Wednesday and Thursday we started drilling for water in St. Etienne. Everyone driving by said it would not be possible. Well, Thursday afternoon we struck water! We are beyond excited at the opportunities this will give our friends and neighbors to access clean water in an area where there are no other wells.

      In other news, my sister and brother-in-law are scheduled to arrive this afternoon for a week long visit.  I have been counting the hours until their scheduled arrival since Wednesday afternoon. To say I am beside myself with excitement would be an understatement. The people I live with will also be glad when Naomi and Zac finally arrive, just so I will quit with the hourly updates.

Tuesday Morning Gratitude

       When I worked in the States, I often felt like my patient's ailments would follow a theme from week to week. One week everyone had COPD, the next week the floor was full of patients with GI bleeds. This phenomenon followed me to Haiti, and it often seems as though many of our patients come in with the same problem on any given day. One week it is hypertension, pregnant teenagers the next week, heartburn the week after that.
      Apparently this is our week for little ones with pneumonia. Our benches have been crowded with worried mamas and babies with horrible, hacking coughs. (I much prefer the weeks where everyone has heartburn.) Yesterday the clinic felt like a revolving door of nebulizer treatments and antibiotics. By the time they got to us these babies were exhausted by the effort of breathing, most of them too tired to even fight the breathing treatment mask. Along with antibiotics and albuterol, we gave out follow up appointments to make sure the children were improving.
         One of those follow up appointments absolutely made my Tuesday morning. Yesterday Michard was lethargic and weak, with that scary, droopy look that toddlers get when they are sick. This morning in clinic we were greeted by a bouncy two and a half year old, racing up and down the concrete path, grinning, playing and giving her aunt fits. Her lungs were clearing, as was her cough. Today I am even more thankful for the grace of modern medicine.
       

Dominican Republic

     A group of us went to the Dominican Republic this week to renew our visas. Twelve hours in the car together one way is a fantastic way to get to know the people you live with even better. Wednesday and Friday were travelling days, and Thursday we had the chance to enjoy the place where we stayed. There is nothing like a day by the pool, Nook in hand to refresh this introvert. I have mentioned before how much I love the chance to sit and soak in beauty when I come across it. Well, Caribbean beaches and sunsets over the water provided plenty of opportunities Thursday. Yesterday we drove back to Haiti, stopping at a grocery store to get some treats on the way. I now have hummus, tortilla chips, salsa and pickles, and I could not be happier.

Conference

     I believe in the communion of saints. This weekend was our annual conference. It was filled with guest speakers, visitors and joy. Sunday morning was particularly poignant. Dawn found us at a baptism service. The sun broke over the mountains as hope songs were sung and brokenness and tears were shed. I believe in the communion of saints.
    I believe in the communion of saints. After a worship service brimming with music and gladness, we held communion. Or partook in the Eucharist. Or had the Lord's Supper. However you want to word it, the bread and wine were present. The invitation was given by the man who baptized the founder of our mission. The wine was given out by one of our pastors. The bread was given out by a pastor of passionate prayer, and men and women from all over this country ate and drank, remembering together body broken and blood poured out. I believe in the communion of saints.
   I believe in the communion of saints. We had people from Texas, North Carolina, Missouri, Mirebalais, Leogane, Lagonave and our own neighborhoods overflowing our benches and spilling into our yard. There was laughter and dancing, prayer and a remembering of the mighty works our God has done. The worship did not always look like what I am used to, but I think it was a foretaste of what "thy kingdom come" could mean. I believe in the communion of saints.

Missions Moment

     In recent weeks, I have inadvertently started running an unofficial kids program in the afternoons after I finish seeing patients. We color, and sing and laugh a lot. It is a lot of fun, although it significantly slows down the rate of my paperwork completion. Case in point- there was a half hour break between typing the above sentences as we divvied up coloring books and picture books, discussed the rules for their use and then discussed what we found in the books. We had conversations about vultures and bears and why you absolutely do not stick your fingers between the blades of a running fan.
    Sometimes I over romanticize these moments, caught up in the beauty and grace (or my perception of the poetry and grace) of them.  Last night was one of those times. We were having the opening session for our annual conference, and one of the little girls I have a particular soft spot for was sitting with me. During the worship time she wrapped her arms around my waist and hugged me, as she sang along with the music. I was entranced by the beauty and sweetness of the moment, totally caught up in the grace of it. Then she stuck her fingers in her nose and wiped the residue on my arm and I spent the next hour and a half wishing for soap and water. Moment lost.
 

To Angelise's banana bread

      In looking back over my posts from the last few weeks, I fear I have given the impression that life down here right now is nothing but jumping precariously from crisis to crisis and wrestling through each day. There have been challenges lately and things have been hard, but that is not the whole story. There are wonderful things going on daily as well. One of those wonderful things is Angelise's banana bread. Angelise is the woman who keeps our guest house running day to day and she's amazing. One day I hope to have half the sense and spirit she does. I also hope to write more about her, if I can figure out how to do it well.
      Among other things, Angelise is a fabulous cook. Case in point, her banana bread. Sometimes she makes it in loaf form. Sometimes she makes it in muffin form. Sometimes when I get home it's cooling on the counter. Sometimes we keep it in our refrigerator (Yes, we have one. We are fancy.). In any form, it is one of the most delicious foods I have ever tasted. It is sweet, and moist and perfect on my tongue. I have an embarrassing tendency to squeal in delight when I find it in the kitchen. Yesterday I ate five pieces and then had to go hide in my room because I could. Not. Stop. This banana bread is in and of itself a compelling reason to come visit us in Haiti.

Chikungunya Update (again)

      Among the clinic challenges this week (not the least of which was figuring out how to deliver albuterol to an infant in respiratory distress in the mountains without overdosing her) was a resurgence in chikungunya pain. When was first researching chikungunya I was warned that for some people the pain could last for months. The research I found made it sound like that was a minority of patients, so I took comfort from that and bumped it down my list of worries in light of more pressing concerns.
      Apparently "can last for months" actually means "comes and goes without warning" and a minority means "most people in some form or another." This week a number of my friends and patients have come to me describing a return, and in some cases an increase, in chikungunya related pain. These are people who had the virus weeks ago, who are suddenly hurting again. A lot. They are also not reporting any real relief from the pain medicines I have at hand. Please keep my friends and patients in your prayers.

Smiles

This little pumpkin came to see me today in clinic at St. Etienne.

Just after taking this picture, she blew me kisses. Some clinic days are sweeter than others.

This one's for the mamas

     One of the very great pleasures of my job is watching moms interact with their little ones. From the new moms cradling brand new lives to the more experienced moms wrangling multiple children while waiting in line to be seen, I love seeing how these women love their children.
    As far as I can tell, mothering is hard, no matter where you live. Including Haiti. Day after day I meet women who became moms, often before they planned to or were ready, doing everything they can for their babies. There was the woman who became a mom at 19, teaching her two year old French, an early way to get a step up in this country. There was the mama of rambunctious twins, exhausted by 8 am and wrestling one child off the clinic shelves while explaining about the other child's illness.  All the activity did not stop her from demanding detailed answers about what was going on with her daughter, and why. Then there was the mom who, while waiting in line with her child, assisted one of our students with his little brother who was boiling hot with fever and crying from the pain in his feet (thank you chikungunya). Day after day I hear women in line, talking to each other about their children, what foods to feed them and how to care for them.
     These days I have women who come in and lecture me about why it is important to breastfeed their babies exclusively for the first six months of life, or how they are helping their children heal from infections. I delight in the creative ways these moms find to get their children the things they need to be healthy. Day after day I get to celebrate with women as I affirm the choices they are making for their babies. Here's to you mamas!
     

Writer's Block

     I have started and discarded no less than three posts in the last two days. Everything I try to write comes out entirely too inane to release on the internet with my name attached. All I really have to say is that I dislike work weeks that start with starving babies and desperate dads, and I much prefer clinic days with a bunch of teenagers bemoaning their acne to the mornings when I have to figure how to prioritize between toddlers with 104 degree fevers.
      Chikungunya continues to run rampant. Someone I respect pointed out to me how blessed we are that chikungunya is not generally deadly, since it is so widespread now. I will take optimism where I can find it.

Graduation

      This week was graduation for the MOHI schools. Thursday was graduation at our Thozin campus in Grand Goave, for the kindergarten, sixth grade and high school. Friday was graduation for the kindergartners and sixth graders at our St. Etienne school. Graduation is a Big Deal here, and I was so grateful to have the opportunity to attend and share the experience. There were demonstrations from the kindergartners about what they want to be when they grow up, and speeches from some of the older students. Unfortunately, in the grand tradition of graduations in my family, I sat too far away and the only pictures I got were blurry. So, here are some pictures others took.

One of the traditions is for a child from the graduating class to pass the torch (or candle) to a child from the next class. Here is a graduating kindergartner from Thozin passing the candle to one of our second year preschoolers.

     Another part of the ceremony involves skits, poems, songs and dances performed by various graduating students. Yesterday at the St. Etienne graduation the kindergartners did a dance about their favorite colors and a skit on the importance of using good manners. Here are some pictures from the event.

Happy graduation everyone!

     

Hope has a way...

        A couple of months ago I wrote about the house fire in our neighborhood that killed one child and left a baby severely burned. Some clinic volunteers and I cared for the baby, Milove as she healed from her burns. It was emotional for all involved. Milove was a trooper, but one of the downsides of being a nurse is when the very sight of you makes a little one cry.
    Milove was back in the clinic today. Not crying. Her burns have completely healed, and the only scarring is a small spot above her right toe. She is walking and talking now, and according to her mama, getting into all kinds of trouble. Hope. It turns it's face to me just when I least expect it.

Counting Gifts

    There are moments of joy in the midst of the general craziness of day to day life here. I savor them as they come. This happened Thursday afternoon after I finished seeing patients:

     

Triaging

      Part of our morning clinic routine involves triaging patients in an effort to keep the very sick from waiting any longer than they have to. That used to mean pulling anyone with a fever and anyone less than a month old to the front of the line. Now, thanks to ckikungunya, we not only pull patients with fevers to the front of the line, but we then prioritize patients based on how high said fever is. Anyone with a temp greater than 103 degrees gets seen first (or as close to it as possible if there is more than one person), then those with temps between 102 and 103, and so on down the line until we get to those without fevers. Add it to the list of things I'm learning to be flexible about.
      I realize it probably seems like all I write about these days is chikungunya. That's because I write about what I am thinking about, and all I think about these days is chikungunya. That's an exaggeration. Sort of. I was naive enough last week to think maybe things were starting to slow down. Nope. There has been a huge influx of cases this week in clinic, and it is striking down our staff (and my friends) left and right. Please keep us in your prayers. Thank you.

Lament

      I have been thinking a lot recently about the place of grief for for the people of God. Or perhaps lament is a better word for it. I love sharing the positive things happening at MOHI, especially in the clinic. I love sharing the victories and the times when hope takes me by surprise. These stories are fun, and remind people (me) of many of the reasons I came down here in the first place. There are many sweet moments spent giggling with the kids, or getting the chance to lavish a new mom with praises about all of the wonderful choices she is making for her newborn daughter.Those thing are only part of the story though.
       Most days are also full of things that demand to be lamented. My friends come to church exhausted because it was pouring down rain last night and their homes leak. A proud father who I have watched play with, sing to and love his toddler daughter all morning has to gather his dignity around himself and tell me that while he knows she would do better if she ate more often, he does not have the money. A woman in the mountains is in full blown heart failure. Another virus is plaguing bodies and magnifying suffering. Severe malnutrition (starvation) is a thing that even student nurses can recognize at a glance.
       I struggle writing this post. I wrestle with how to word what I am thinking and feeling. The last thing I want to do is be another foreigner who, in my ignorance or willful misunderstanding of the dignity and nuance of the people I love, devalues them. That being said, I am also coming to believe that part of the role of the people of God is to perceive the brokenness around us. To see suffering and lament it. I believe in the ultimate healing and putting right of all things as they are under the Lordship of Christ, but we are not there. Right now is the time of the "not yet." It is the time of starving babies and fevered joints. It is the time of limited healthcare options becoming even more so as funding dries up and organizations pull out. It is the time of sweat and tears. It is the time of a brokenly whispered "come Lord Jesus" and a desperate hope the He will. Soon.

The View from Wednesday

This is what I get to look at out the mobile clinic windows on Wednesdays:

     It's a rough life, I know.

Chikungunya update:

It is still everywhere and still causing a ridiculous amount of suffering. Please keep praying for my friends and patients as they fight this disease.

(Bonus points if you know where I got this blog title from!)