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.

   

Getting to know the services

One day last week I went to visit the rehab centre (CRF) that has a prosthetic-orthotic division, upper extremity splinting, and a small cerebral palsy program for kids (initiated by Isabelle).

In the morning I "hung out" with some of the beneficiaries getting new prosthetics, and although I was thoroughly impressed by the dedication of all of the clients, most memorable was a very elderly woman giving advice to a very young and 5 month pregnant woman, as they each practiced walking with their new devices.  As you can imagine, learning to balance on a prosthetic limb is that much more challenging when you're also carrying a baby.  The beneficiaries come to the centre to practice walking with their new prosthetic limbs until the rehab team feels they are ready to bring their limb home and use it in their own environment.  In one of the pictures you'll see a woman practicing up and down on a step.  She explained to me that she couldn't go home until she could do this, as this is the type of step she has to be able to manage in order to use the "tap tap" bus to get around.

In the afternoon I went out with a physio expat, a local rehab tech, and an interpreter to do some home visits in search of potential clients for the CP program.  The rehab tech is learning about "normal development" and how to identify children with delays (and CP) under the guidance of the PT.  We visited two different families--the first a little boy...spastic diplegic (in my humble opinion), who was also non-verbal.  Right now there's no SLP services offered at the rehab centre, and although I pushed to try to get them started, I was  told that right now it's not in the mandate (HI is still in the emergency phase).  There is a slow move towards the more development stage, so hopefully it will be considered down the road.  In the meantime, I think I might just introduce the communication book I happen to have brought along....

Preliminary election results

Yesterday we left work early in anticipation of the preliminary election results.  Instead of going straight home we were instructed to stock up on food in case we were on lock-down for days to come.  So, we headed to the GIANT (as the name would suggest, a giant grocery store), and found ourselves in bumper to bumper traffic with every other expat in the city attempting to do the same thing.  Weaving between the red cross, doctors without borders, oxfam, healing hands, etc...we made it to the store and home in one piece.  Needless to say, that our preparation was all for nothing (thankfully) as the election results did not provoke any massive rioting.  Martelly (the former singer) won, and there were reportedly many people celebrating in the streets.  We can only hope that everyone will continue celebrating as he certainly has a major challenge ahead of him, rebuilding this country.  

strength amidst the piles of rubble

After 5 days in Haiti, I'm settling in quite nicely.  There's been a lot of orientation and security briefings, and it's slowly starting to make more sense.  For those of you who don't know, my job has changed slightly.  I ended up replacing Isabelle in the position of conseiller technique en readaption.  From what I can tell so far, this involves program evaluation, creating and implementing tools to help the rehab teams do their assessments, finding ways to measure change, training staff and community partners, etc...

So, as a step in starting to understand the different programs, I get to spend time doing field visits in the next little while, which I'm very excited about.  On Isabelle's last day we went together to one of the "Antennes" (essentially an outreach clinic), and into one of the camps to do a "home" visit (see pics).  We had the opportunity to see a young woman with a below the knee amputation, managing extremely well with her crutches in very rugged terrain.  Unfortunately she has to have surgery again on her stump, and she is understandably very nervous; however, we were there will a local physio, rehab tech, and psycho-social worker, who did an amazing job explaining the importance of the surgery to both her and her husband.  

It's raining right now, and we're safely tucked into our house, but I can't help but wonder about all the people in the camps.  For sure their shelters are not keeping out the rain, and I can only imagine how wet and uncomfortable they must be, not to mention the increased risk for the spread of bacteria.  What's shocking to me is how long post-earthquake it is already, and how many people are still displaced in camps, will no sign of change in the near future.  Unbelievably, in our walk through the camp we still heard a lot of laughter and music, and saw kids playing like they didn't have a care in the world.