The end of a mission

It's kind of hard to believe that it's been three months already.  I'm sad to say goodbye, but I feel good about what I was able to achieve in the short time that I was here.  On Friday I went to visit the first young lady that I ever saw for the accessibility team.  You might remember that I posted a picture of her in her house up on the hill, with steps leading down to the car that she clearly couldn't navigate in her wheelchair.  Our work is almost finished, and you will see that she now has a ramp right from her balcony all the way down to the car, not to mention her own private shower in the backyard.   

Before

After

It's a small drop in the bucket when you consider all the needs in this country, but I am happy to have touched the lives of these people in some small way.   

I will miss the strength and perseverance of the people, the music and the singing, the laughter and the tears, the scorching sun and the crazy rain, the productive and draining work days, and the hellos and goodbyes of all the staff.

But I am very excited to come home, especially with all of this now a part of me.  

See you soon,

Emily

In the name of sustainability

Seeing as HI will not be in Haiti forever, the idea is to try to impart as much of our knowledge (regarding accessibility) to our Haitian partners as possible.  Last week I assisted in a workshop given to local construction workers, animated by the architect, engineer, and OT assistant from my team.  Below are pictures of them doing simulation activities so that they can understand what it's like to have a disability and what kind of barriers you might encounter.  I think that the experience was very valuable for them, and hopefully it will change how they think about building (universal design meets Haiti?)   

I also did a workshop to our HI staff that are in the field everyday.  The goal was for them to learn to properly identify accessibility issues and be able to brainstorm solutions, taking into consideration the beneficiaries' limitations and the environment.  Here are some pictures of them doing a hands-on activity--determining what materials are available and how they can used to resolve specific accessibility problems. 

a day in the life

A lot of people have been asking me what a typical day is like here.  It goes something like this.

5:30--Wake up to sound of barking dogs.  Fight the urge to go outside and throttle them.  Wonder about my violent sentiments seeing as I consider myself a dog person.  Turn over and go back to sleep.

6:15--Slowly start the getting up and getting ready for work routine that involves negotiating the sharing of the bathroom, the kitchen, etc..with my 10 roomies, followed by eating a hearty breakfast prepared by the cook that is waiting for us on the terrasse.

7:00--Pile into the cars waiting to take us to the office.  Bump along through shortcuts and traffic jams, observing life on the streets of port-au-prince through the window.  Sometimes listening to my ipod, sometimes talking about Haiti with the driver, sometimes debriefing work or planning weekend adventures with my fellow passengers.

8:00--Arrive at the office.  Wash hands with chlorine (the first of many times this happens in a day, which means you constantly smell like a swimming pool, but feel protected from cholera).  Enter the office to a flurry of activity as everyone prepares for the day ahead.  Lots of greetings all around--two kisses for the french, and a  'Komon ou ye' for the Haitians, to which the appropriate response is 'en forme'.

9:00-5:00--The work day.  Either at the office, an old house that HI has rented and turned into office space, where everyone is working away at their computers, or engaged in meetings--your typical office setting really (only much hotter with no air conditioning and a constant flow of coffee, which i think is the French influence).  Or in the field, which essentially means different neighbourhoods in port-au-prince.  When this is the case, we drive from one beneficiaries house to the next, which can sometimes take hours because of the traffic, and the fact that addresses are assigned somewhat arbitrarily.  Finding a house usually means stopping 5-10 times to ask people for directions, but luckily somebody always knows somebody, who knows somebody else, who knows the person we are looking for, and the process is always very entertaining.  We eventually get to our destination do do our evaluations which is the best part as that's when we really get to know the families, how they live, what their lives are like, etc...  

5:00--Everyone meets back at the office.  Generally people are either hot and cranky or excited and exhilarated depending on their activities of the day.  Then begins the process of bargaining for a place in the car for the ride home.

7:00--Usually arrive home by this time, although sometimes it can be later depending once again on the traffic.  Gather remaining energy and do some kind of exercise to make up for the fact that most of the day is spent sitting.

8:00--Eat dinner left by cook in the fridge and re-heated in the microwave, or maybe go out for a meal at one of the MANY nice restaurants.  Hang with roomies, watch a movie, read, work, or catch up on emails, etc....

10:00--Start the getting ready for bed process (5:30 comes early).  Bug net.  check.  Fan.  check.  Head lamp.  Check.

11:00--Good night!

The breakfast table

The drive to work

My colleague at the office

Street scene

  

on the job

Lately we've started doing re-evaluations of adaptations that have been done between January when the project started and now, just to make sure everything is going well.  Most of the time the beneficiaries couldn't be happier and we've taken wonderful videos (which unfortunately won't upload here) of them telling us how much of a difference the adaptations have made in their lives.  A lot of time it's the difference between being able to leave the house or not, being able to work or not, or simply being able to go to the bathroom independently.

Sometimes, we run into situations where the adaptations are not going as well as planned, and the re-evaluation gives us the chance to see that, and take the steps needed to fix it.  Here are a couple of pictures of me measuring a ramp that accidentally dips down to one side, and observing a young man doing his transfer from his wheelchair to the toilet over a large block of cement.  The block was built to prevent water from going from the shower to the toilet area but is clearly in the way of the transfer.  We have since fixed the ramp and removed the block so he can safely use both areas on his own.

     

Weekend adventures part 2

I've been keeping it a little bit more low key lately, and staying around Port-au-prince on the weekends.  I spent one weekend with a lovely Canadian couple who have lived here for over 30 years (friends of a friend I met here).  They have a very cozy home nestled in the picturesque mountains, an abundance of fresh non-haitian food, and a TV--all very exciting things.

The view from the house--note the meditation bench

Zoomed in

This weekend I stayed home, but our house hosted a party complete with two live bands, for all of the national and expat staff from HI and other organizations.  I think it was quite a success.  Here are a couple of pictures of the band and the dancers...a little blurry, but it gives an idea of the scene.  

Welcome sign--copyright Emilie Forestier, the architect I work with

   

Day off

As I was groggily getting ready for work this morning, there was a knock on the bathroom door, and I opened it to find my colleague reporting that the president had suddenly declared it a national holiday.  It sort of has that snow day kind of feel; we all took off our HI t-shirts, got back into our PJ's, and crawled back into bed!    

Since I'm spending the day at home, I thought I would add a few pictures of life around house 5.

Me playing with the 11 new puppies 

Evening aerobics to make up for the fact that we sit in a car for 5 hours everyday and can't walk anywhere

Sunday night family dinner--the only day of the week that the cook is off and we have to fend for ourselves

feeling powerless

With all the good will in the world, sometimes there's just nothing that can be done.  I was faced with this type of situation twice last week.

The first was when visiting a women whose house had been totally destroyed in the earthquake.  In its place she has a tent, donated by another aid organization, that she lives in with her whole extended family.  Because she now walks with a walker, she can no longer leave the area where her tent is located, so her entire living space is now the tent, and the 5 feet outside of the tent.  Unfortunately there is no possibility of installing a ramp of any kind given the terrain....and she has no money to relocate to somewhere else.

      

The second situation was later in the week when I went to visit a little girl with Cerebral Palsy in one of the camps.  When we arrived, the door to the shelter  was locked with a padlock, the girl was inside, but the mother was nowhere to be found.  We inquired with the neighbours who explained that the mother had gone to sell goods on the main road.  We managed to find the mother, who knew full well the dangers of leaving her daughter at home alone, but sadly, could not find a way around it.  She has no other family, and her only way of making any money to support herself and her daughter is to sell goods.  The main road is far away, and the terrain to get there is rugged, so it would be impossible for her to carry what she is selling, as well as her 5 year old daughter who can't walk, there and back everyday.   My heart just broke, because although this situation has youth protection written all over it, the mother truly wants the best for her daughter, but is trying to achieve this in a country where there is no system in place to help her.   

My first evaluation

Here are a couple of pictures from my first evaluation.  This young lady is paralyzed from the waist down as a result of a bullet wound.  She lives in a nice part of town, in a large house up on a hill.  Unfortunately, the once desirable hillside, is now the cause of many of her problems.  Right now she needs to be carried in and out of the house and down the hill to the car if she wants to go out into the community.  She can wheel around her house but it's a tight squeeze to fit through the door frames, and because she can't get into the bathroom, she has to take a shower in the backyard.

The bathroom is a hopeless situation, but we will build her a shower in the backyard, complete with a curtain to give her more privacy.  We will also widen the door frames so that she can move around the house more easily and build her a ramp so that she can get off the front balcony independently.  Getting to the car is more of a challenge as it's a long way down, but we're looking at the possibility of either building her a long winding ramp, or making a driveway so that the car can come to her.  Right now we're negotiating with contractors and her uncle who owns the house, but hopefully the work will start soon and I will still be in Haiti to see the end result!

   

Quick change of events

I've just come back from a wonderful week long vacation in Guadeloupe and I have five more weeks to go in Haiti.  I have to say that when I came out of the airport in Port-au-prince, it kind of felt like coming home.  It's amazing what you can get used to.

I've also come back to a new job.  I had always wanted to do more hands on work and the agreement that I had made with HI is that I would switch jobs if ever they found someone to replace me.  I was sort of convinced this would never happen but in a crazy turn of events they found someone, and at the same time a position opened up with the accessibility team, which is where I am now.

The team is lead by an OT and made up of an architect, an engineer, a logistician, an OT assistant, and myself.  Basically the team gets referrals either from within HI or from outside organizations for beneficiaries who have accessibility issues because of a disability.  Usually this means they can't get in and out of their house, they can't access certain parts of their house (such as the bathroom), or they can't be functional in their house (such as use the stove or wash the dishes).  My role is to assess the needs of the beneficiaries and figure out what they can't do vs. what they would like to be able to do, and then work together with the technical team to figure out what adaptations can be done to make this possible.
I've only done two evaluations, but so far I love it.  It is very hands on and very concrete, and I think that I will be able to see some nice results in the short time I have left.

I don't have any pictures to show yet of the adaptations, but here are two examples of houses that have been destroyed in the earthquake--one in the city and one in the country.

This is basically what you see all over, as the demolition phase is very very slow.  Apparently it was decided that rather than use foreign aid to bring in heavy machinery to clear out the rubble, they would create cash for work projects that would employ Haitians to do it by hand.  The other day I was stopped in traffic and I watched a man chip away at a large stone wall with a hammer. After 10 minutes he triumphantly held up a 2 ft. by 2 ft. block of stone, tossed it in a large dumpster, and proceeded with the next chunk.   While I'm all for supporting the local economy, I can't help but wonder if it would have been more efficient to clear out the rubble quickly, and then have cash for work projects for the rebuilding phase instead.        

A few things i love about Haiti

1) The singing.  Everyone sings, all the time.  Especially the men.  It can be anything from Shaggy or Billy Joel, to Creole rap or traditional Haitian songs.  When we were on the beach in Petit Goave we bumped into a group of teenage boys who wanted to know what we did.  We got to talking, and so I asked them what they did, to which they responded "nous sommes des chanteurs".  So I said, "if you sing, sing for us", and right there on the beach they broke into song.  I have a video, but unfortunately it won't upload.

2) The honking.  Here you honk to say "hello". You honk to say "goodbye".  You honk to say "go ahead".  You honk to say "don't go, I'm going".  You honk to say "thanks for letting me go".  You honk to say "why did you go, I was supposed to go".  You honk to say "move out of my way".  And sometimes you honk just as a warning that you're coming round' the corner.  I honestly can't figure out how it makes any sense, but they all seem to understand each other just fine.

3)  The shoe shining.  It's going on 24-7 on every street corner.  Old men.  Young children.  It can be leather loathers, or Nike running shoes, there's really no discrimination.  But the best part is how much importance is placed on the shoe shining, given the fact that everyone is walking through unpaved, mud covered streets, weaving in and out of piles of garbage, and dodging goats and pigs along the way.  I find myself wondering how often one needs to get their shoes shined.

4)  The shower cap.  It is totally acceptable to pull a shower cap out of your bag and put it on when it starts raining and walk through the streets with your new do.  I have to admit that after blow drying my hair at home just to discover it's raining outside, I've often wished for a solution...this might just be it!

    

wheelchairs

Breaking news on the wheelchair debate.  After a lot of thought it was decided that we should get a mix of supportive seating (for use in the house) and specialized wheelchairs (more for mobility in the community), and carefully select who should get what.  So off I went to Johanniter hospital just outside of port-au-prince to try to strike a deal with them to get some of the equipment that they had already ordered.  As luck would have it, they were more than happy that we got in touch with them.  They were actually looking to partner with another organization to distribute their equipment as they don't have the manpower to do so.  So, in about a month, HI will have 90 seats for 90 children who are very much in need.  Here is an example of the supportive seating...the seats come from a company in England called Motivation that specializes in wheelchairs for developing countries.

Other than wheelchairs, I've been involved in the planning of the exit strategy for the Antennes (outreach clinics).  After the earthquake 4 different Antennes were created to offer services to people with disabilities in different communities.  Initially the services were for people who were injured in the earthquake, but they quickly expanded to be accessible to all people with disabilities.  Now, more than a year and a half later, the funding for these Antennes will be ending, however the Antennes are still receiving new beneficiaries everyday, and some of the old beneficiaries still have ongoing rehab needs.  So, the big question is what to do now.  We definitely haven't come up with all of the answers but the process has been very interesting.  The goal of course is to find local organizations to partner with that can maintain some of the services, but in a country with no formal rehabilitation training programs, this is a challenging endeavor.  HI together with a few other NGO's has put together a proposal that includes a 4 year training program for rehab techs that would be recognized by the government in Haiti.  Fingers crossed it goes through.

small successes

Often I'm working behind the scenes, but the other day I happen to be in the right place at the right time, and got to work together with the physio to do a communication/feeding intervention for a six year old girl. The little girl is non-verbal, and was also being fed cradled in her mums arms, with her head tilted way back in hyperextension to make sure the food stayed in her mouth.  This seemed to be more out of habit than necessity, because the girl actually had very good head control, not to mention quite good oral motor skills.   We used boardmaker with Creole words for her to make a choice about what she wanted to eat and then provided education to the mum on proper positioning for feeding, how to present the food, the risk of aspiration etc...By the end of the session not only was she making a choice between two things, she was also actively involved in the feeding process and even attempting to hold the spoon that we adapted for her.   It was definitely one of those feel good moments.

  

The streets of Haiti

Easter with the Rara

I spent easter weekend just outside of the town of Jacmel in the south of Haiti.  We stayed in a cute little hotel on a small, and locally frequented beach that was actually surprisingly clean.  Because it was easter, we were frequently engulfed by Rara bands, which essentially are processions of haitians dancing, singing, playing instruments, and doing vodou as a way to speak out about politics, poverty, etc...Apparently the celebrating can turn violent, but minus a slight run in with a guy holding a machete who wanted money for the picture I took, we emerged unharmed.

The rest of our time was spent lounging on the beach and exploring bassin-bleu, a series of swimming holes and waterfalls with very turquoise water.

Moving right along

Things have gotten busier at work in the last little while...and as most you know, this makes me very happy.  Last week I started doing focus groups with the staff at a few orphanages to learn about their day to day challenges and how we can help.  So far I see a high need for training on proper positioning and feeding techniques, and of course equipment to allow these strategies to actually be put into place.

Along the same lines I've been working to get Handicap International (HI) to accept to order pediatric wheelchairs.  This is a complicated issue as while the need for proper positioning is clear, there are questions about the maintenance of the wheelchairs once HI is no longer as present in Haiti, as well as the true feasibility of mobility in the chairs given the physical environment.  There has been a healthy debate over whether it is better to use local resources and make basic positioning for within the home, or whether to go ahead with the wheelchairs regardless of the limitations because of the importance of social participation.   In the end, I suspect that we will have a combination of the two which hopefully will meet the needs of most of our clients.

Here is an example of a little girl who is in desperate need of a proper wheelchair.  When we arrived at her house she was sitting outside in this chair, with her arm draped over the back for stability as there was no seat belt, trunk support, vest, etc...She has athetoid CP, is non-verbal, and is clearly very intelligent.   As you can imagine I wanted to take her home and hook her up with a powered wheelchair and a communication device ASAP, but clearly that isn't possible.  Luckily she is participating in the CP program that started just recently at our rehab centre here.   

The last few days of my week were spent in Petit Goave...a smaller town a few hours from port-au-prince where we have another Antenne.  The security rules are more relaxed there and we were allowed to walk to work and peruse the local market...a welcomed change!  I did a training on functional evaluation, goal setting, and using contracts with the beneficiaries as a way to monitor the change in their rehab process and determine when they are ready to be discharged.  I've seen a serious need for this as I read through charts and realize that certain beneficiaries have been seen 1 x a week since the earthquake, and might continue to be seen 1 x week for the rest of their lives...even if they aren't making progress.  I'll admit that my audience looks a little bored in the picture, but I've been telling myself that they were just trying to take it all in.

    

Weekend adventures

If you're willing to bump along in the backseat of a car for a couple of hours, there's no shortage of things to do in and around port-au-prince.  So far I've been to the beach for the day (the old club med) and hiking in the mountains through some of the little villages nearby.  The expat "scene" is also quite extensive so tucked away next to a tent city, or beside somewhat of a slum area, there are also lots of fine dining restaurants to be found.  There's something about it that feels very wrong, yet I must say that after a day in the field, it's nice to have the option of having a cold beer in a beautiful garden restaurant.

    

Unfortunate patterns

The more visits that I do in the community, the more I am starting to see a pattern emerging.  There is a shockingly high number of young adults (25-35 year range) who have suffered from a stroke, and as a result are paralyzed on one side.  The cause is hypertension...so essentially it comes down in a large part to their diet...and it doesn't take long to see that the more affordable, yet deep fried meals being sold on the side of the road are a contributing factor.   I had my first taste of deep fried chicken with deep friend plantain and french fries the other day for lunch--it was delicious, but a lot like eating take-out from KFC.  On a more positive note, I observed a beautiful transdisciplinary intervention the other day, when a Haitian physio taught a young lady who was a few weeks post-stroke, one-handed dressing strategies so that she could dress herself.

Also common are orthopedic complications related to fractures from the earthquake.  Right after the earthquake there were tons of organizations that came in to assist with surgeries.  While this means that people got the surgeries they needed, it also means that when the situation was no longer considered urgent, these organizations withdrew, and as a result there was very little follow-up.  Below is a picture of a woman who had both hip and knee surgery.  She had initially been given a wheelchair, crutches, even an adapted shelter with a ramp, but hadn't been seen since.  When we found her she was still unable to walk without the crutches because of a significant leg length discrepancy of about 4 inches and was in a lot of pain due to her abnormal walking pattern.  Another surgery to correct the situation will cost 2000$ that she doesn't have, but hopefully a pair of adapted shoes that we can provide will at least allow her to walk more functionally.