A Walk Through Leogane

We walk everywhere we need to go. The main mode of transportation here, motorcycles, are kind of dangerous because there is so much traffic on the roads so we stick to walking. What do we encounter on our daily walks through Leogane to the tent cities where we perform the verbal autopsies?

Well once we step out of the clinic we hear our neighbors shouting our names and running towards us to say hi. I don't think I have ever left the clinic without them knowing! As we walk down towards the center of town, the main thing we have to be careful of are all the motos and tap taps zipping by. The motos like scaring foreigners by coming really near them as they drive by and they honk way too loud for their size! The motos are the main mode of transportation in Haiti - they are like taxis in the US or rickshaws in India. They are mostly used to travel short distances like to the store or hospital. Tap taps are the other mode of transportation...although these are used more for transportation between places further apart such as between two cities. They are basically big trucks painted with bright colors and usually filled to the brim with people. They are called tap taps because you basically "tap" when you want to get off.

An unfilled tap tap...a rare sight...usually they are overflowing!

As we get to the center of town we usually see school children coming back from school. They have really beautiful uniforms that are very neat. All the girls have socks with beautiful lace on them. A funny thing about the school children is that we see so many boys, even older boys, carrying around pink, american princess backpacks...I don't quite understand why? Oh, and a lot of times people will wear shirts from US but I dont really think they know what the shirts say. For example Missy was telling us that she saw a relatively large man in his thirties wearing a shirt that said "Daddy's little girl". I have seen several older women wearing shirts that say stuff like "In need of a boyfriend" of "Top reasons you should date me". Once we even saw someone wearing a Duke jersey...I dont think they knew that what they were wearing sold for so much in the states!

Throughout the streets the women are usually selling various items...from food to clothing to medicine. Little kids try to sell us bags of water...they are these little bags the size of a typical ice pack which are used like we use water bottles in the states. Also on the streets we usually run into dogs every 10 or so steps we take and goats every now and then. The dogs avoid the humans for the most part, which means I don't have to worry about them!

On a more somber note, its hard to notice the lack of buildings on our walks. Sometimes we pass through areas that are literally ghost towns. What once used to be a neighborhood is just rubble with only door frames still standing. Then we enter the tent cities where the people are now living and you can't help but think what is going to happen when the rainy season really hits. Some of the tent cities we go to have nice camping tents donated by AID agencies such as USAID, but then there are other where literally its a dirt floor and 4 sticks connecting 5 pieces of cloth.

Usually around 12 or 1 pm when we head back the clinic, it starts pouring on us, which I don't mind because it finally cools down! But the walk gets a little slippery. Once I made the mistake of wearing flip flops after it had just rained and I kept sliding out of my flip flops right into mud. As we approach the clinic we are, of course, greeted by our neighbors and all the children running up to say hi :) Its a nice way to be welcomed home!

A Haitian Vacation

I didn't even realize I was calling the clinic "home" until Julie pointed it out to me one day. After a month of being here, the clinic really feels like home. We are relieved to come "home" from a day of work in the hot sun. We help Dr. Merisier prepare "home" for visitors like the 17 person medical team that came last week. We went on a mini-vacation to Jacmel this weekend and as we approached familiar streets I was excited to be "home" again.


So about this Haitian vacation...it was incredible! At times I forgot I was in Haiti...Jacmel is a beautiful oasis hidden in the mountains of Haiti. We let ourselved indulge a little...okay maybe more than a little...for 2 days. On Saturday we checked into the Cyvadier Hotel in Jacmel and were greeted with delicious fruit punches. From the hotel we had a beautiful view of the ocean!That afternoon we went to the public beach where we had fresh fish and plantains, which were both very delicious! Swimming at the beach was amazing cuz the water was soo warm...I wish California beaches had such warm water. When we came back to the hotel we had hot showers, AC, and a buffet...it literally felt like the most luxurious place ever just because of these three things.


The next day was quite an adventure. We went to Bassin Bleu, which is basically a series of gorgeous waterfalls pouring into basins. Getting there was the adventure - it involved riding motorcycles up mountainous terrain, crossing a river on foot, and using a rope to climb down rocks. So the motorcycles picked us up near the hotel and took us through moutainous terrain until we reached a flowing river. We got off the motorcyles, held hands, and waddled our way through the river keeping our legs wide apart so as to not be thrown off our feet by the current. The motorcycle took us up the moutain some more and at points we were too heavy for the motorcycle so we had to get off and hike up. As we got higher we saw beautiful views of the ocean and mountains!


Missy and Kathy along with some of our Haitian friends crossing the river!


Finally we got to a point where motos could go no further so from there we hiked. Thats when we reached the rocks that needed a rope to climb down. We crossed several streams, passed several waterfalls, and with the help of the Haitians we were with reached the topmost waterfall. It was so nice. We jumped into the water from near the waterfall and it truly felt like a paradise. Our lunch consisted of fresh avocados and coconuts...yuuum :) The whole trip showed how much potential Haiti has to be a tourist destination and the hidden beauty that the beaches and mountains of Haiti possess. Jacmel used to be a popular tourist area before the hurricanes and earthquake. I really hope one day it can flourish again...its such a cute, picturesque little town surrounded by beautiful beaches and mountains.

The girls by the waterfall. Top row from left to right: Genevieve, Hannah, and Missy. Bottom row from left to right: Kathy, Julie, Julia, and Shilpa

Maternal Health in Leogane

This week we started our maternal health project! A few months ago, the women’s group in Leogane had identified maternal mortality as one of the greatest concerns of the community. Therefore, Family Health Ministries has started a Safe Motherhood Initiative to make pregnancies safer in Leogane. This summer, Julie, Julia, and I, are looking to identify the most common causes of death of mothers during or right after pregnancy. Family Health Ministries can then use this information to work with the community in designing programs that will make pregnancies safer. The way we are identifying the most common causes of maternal mortality is through the World Health Organization’s verbal autopsy surveys. We are surveying family members of women who have died during pregnancy. These verbal autopsy surveys ask a series of questions about the death such as “Did the woman have a headache?” and “Did the woman have swelling?” The answers to the questions are then analyzed to determine what the cause of death of each woman was.

The way we are finding families of women who have died is basically by word of mouth. We are going around Leogane telling people about our project and asking whether they know anyone who died during pregnancy. At first it was frustrating because we would find family members willing to talk to us and we would tell them to come to the clinic the next day and then they would never show up. We soon realized that we have to be the ones to go to them and not expect them to come to us. So now we go around a tent city identifying people who are willing to talk with us and the tell them we will be back the next day to do the verbal autopsy. Another reason that our project has been making progress, which is really sad, is that maternal mortality is a much greater problem here than I imagined. I’d say about ¾ of the people we talk to have a relative who died during pregnancy. Its difficult to see grandmothers taking care of 4 or 5 children whose mother died during pregnancy.

This week we did 6 verbal autopsies, which is much more than I expected for the first week. Several things have surprised me so far. First is the willingness of people to tell the stories of women who have died. I think part of this reason is the desire to make known the frustration that many people have with the current state of healthcare in Leogane. Another part is the desire of the community to support a project that will make pregnancy safer for other women. Another thing that has really surprised me is the coexistence of belief in Voodoo and medicine. Many Haitians practice Voodoo, a religion that combines West African beliefs and practices and Catholicism. When we ask family members what they think caused the deceased to die, we often get the response of magic or a curse. According to Voodoo beliefs, sickness can be sent to someone by another. What is interesting though is that many Haitians have these beliefs and at the same time take Western medications for their illnesses. I am only starting to realize this coexistence and I am finding it fascinating.

Everthing else is good here. We have been eating a lot, but also doing some intense exercising in our down time thanks to Hannah’s exercise videos! Some of my favorite meals here have been tiaka…it’s a pumpkin soup with like 10 other ingredients and its delicious, mayi moule…a cornmeal dish eaten with legumes, beet and potato salad, and this really yummy type of scrambled eggs they make here with like onions and peppers and some kind of meat. Also, fruits here are delicious! Dr. Merisier showed me a couple days ago how to eat a mango Haitian-style. It involved no utensils, just ur mouth and hands. It was a mango from his tree and it was delicious! I also love the bananas, papayas, cherries, and coconuts we get here. Oh and almost every meal we get either passion fruit or lime juice!

Eating coconuts that McKenzie got for us after climbing the coconut tree.

One of the kids in the neighboring tent city with her coloring sheet :)

Nail polish, Soccer, the Beach, and Salsa

These past few days have been so much fun! (I promise we are going to start our projects this week). On Thursday we went to visit the mountain community of Fondwa. In Fondwa, FHM sponsors an orphanage and school. I have to admit the hike to the orphanage was pretty strenuous…I am still sore! It was about 2 miles steep downhill going to the orphanage, which means steep uphill on the way back. But it was very well worth it! Playing with the kids at the orphanage was a lot of fun! I took out nail polish to paint their nails and all of them swarmed around me wanting to get their toenails painted.

Painting the nails of a girl at the Fondwa orphanage! Photo courtesy of Julie Rivo.

Friday was a very soccer-filled day. In Haiti, world cup fever is everywhere! In Fondwa, kids were humming “wave your flag” as we walked by. There are signs everywhere advertising places where the world cup games are being shown – “5 goudes per game” many of the signs display. All of the commercials during the world cup are so much more creative and lively here in Haiti than back in the States. In all the commercials, there is dancing, singing, and some product, whether it is a milk carton or coffee bag, playing soccer. In addition to watching soccer, we have been playing soccer with the kids around the community. Most of our games turn into keep-away instead of an actual game, but they are still very fun!

On one of our many walks. The roads are so rocky and rough that my teevas have already come apart! Here we are probably moving aside for a moto that may run us over if we dont move. Photo courtesy of Vivide Chang.

So on Saturday we took a trip to a beach in Leogane. I have to admit, I had very low expectations after living in California all my life. But the beach was pretty impressive! The water was very warm and relatively clear. We took a handmade canoe to an island…the “driver” of the canoe told us that it took 3 years to make the canoe and it would last for 12 years. Nitin, the canoe reminded me of your solar boat! On the island we went swimming for a while, ate coconuts, and ate conch until we got rained out.

Then, that night, we went salsa dancing! Julia is an amazing salsa dancer and she gave us all lessons before we went to this little salsa club. I was, of course, pretty shy to dance at first but Frandy and Vivide finally convinced me to and I have to admit it was a lot of fun. Oh, I don’t think I have introduced Frandy and Vivide! Actually I don’t think I have introduced anyone…so let me do that so you aren’t confused. So Julie, Julia, and I are the Duke Engage students here for the summer. Our project coordinator is Hannah. We are staying at Dr. Merisier’s clinic. Dr. Merisier lives here with his wife Diane and their son Junior. Junior is adorable, likes to scare me and watch me pretend cry afterwards, and use my contacts case as his race car and my ear plugs case as microphone to sing. Vivide and Genevieve are graduate students also living here for the summer and doing research. Missy is a FHM volunteer who is like our Haitian mother. She speaks Creole very, very well and has really helped us to get to know Haitian culture. Frandy is Dr. Merisier’s half brother. He is awesome because he helps us with our Creole but he is not so awesome because he is rooting for the Celtics! Yeah, its crazy, I get to sometimes watch Lakers games here! Its amazing how universal things like sports are.

Today we are meeting with the women’s group of Leogane to introduce our project and ask for their input. I am excited to start the project!

More pictures!

The three of us (me, Julia, and Julia)! Julie and Julia's hair is down...but once we reached Haiti, all of our hair is constantly in buns because of the heat!

The tent city outside the clinic. We met the family in the front, left tent and they are very sweet. They have hardly anything and yet they gave us a dolphin can opener as a present the second time we went to visit them. Whenever I am on the roof of the clinic, the kids from the tents come out and yell for me to come down.

Picture...which takes forever to upload!

The children in a school in Leogane - they all love taking photos and then when they see themselves in the photo they yell "mwen menm! mwen menm!" (its me, its me!). As you can see in the picture, they all wear very neat uniforms. The girls even have socks with lace on them!

For additional info...

Look at our official DGHI blog that Julia is keeping:

http://dukejewels.wordpress.com

The Beginning! First Impressions...

It’s quite a sight up here on the roof of the clinic we are staying at. To the left of me is a small tent city with about 100 tents. As we were landing in Port-au-Prince Sunday, I saw hundreds of blue and white roofs from the plane, which to me looked like houses. It wasn’t until we were almost on the ground that I realized they were actually tents. It is hard to imagine how entire families are living in tents about the size of my bed at home. When the wind blows by and the tents flaps are lifted, I sometimes peek inside and there is barely anything inside other than sleeping space. On the other two sides of this roof is rubble and buildings that have completely or in part collapsed. It is hard to imagine that these buildings were once homes. The homes of the people now living in the tents.

Yet, life in Haiti is surprisingly bustling. It is very alive with things constantly going on. Outside our window all day we hear motorcycles honking and people talking. Then at night the dogs start barking and the roosters start early in the morning. We went to the market today and it was so lively! It reminded me a lot of the markets in India. People are really friendly…almost everyone we make eye contact with, a “bonswa” (Haitian greeting) is exchanged, which is very different from the states. As we walk on the streets, all the kids call us “blan” (white), yes, even I am called “blan because they call all foreigners blan. We are trying to practice our Creole, often with kids. I personally did not realize how significant the language barrier was going to be because I have never been to a country where I didn’t speak the language. But people are really friendly and encouraging us to speak in Creole. Another thing, the fruits in Haiti are amazing! We have been drinking all kinds of fruit juices like cherry juice that tastes like strawberry juice and passion fruit juice. From the roof up here you can see several fruit trees including a enormous mango tree!

We haven’t started our projects yet as we are just acclimating. I have to say, it is much hotter than I expected. I am not used to sleeping in a mosquito net in the heat and wearing bug spray even when I sleep…it makes me feel icky all the time. I never thought I would be taking showers with a flashlight and would crave for coldness. After tenting at Duke, I hated the cold. But now a freezing cold shower is what I crave and this morning, when I woke up because I was cold, I was shocked and didn’t want to put my bed sheet over me just because it was a rare feeling here…I didn’t think it was ever possible to be cold in Haiti.

Today we went to visit the children of this school in Leogane. It was such an amazing experience. The school was wonderful, all the kids dressed up in cute uniforms, and very polite when we entered. Then when we started to play with them they went absolutely crazy! They took my soccer ball and were running around everywhere. Of course I never got the ball back. And all of them wanted photos taken of them…”pran foto, pran foto!” they would yell. When I showed them their photo, they would yell “mwen mehm, mwen mehm!” (its me, its me!). I started to tie one of the kids shoe laces and when the other kids saw, they immediately began to untie their own shoe laces so that I could tie theirs too.

4 days, 3000 miles, and 2 planes till 1 incredible summer

Bonjou!

My name is Shilpa Agrawal and I am a rising junior at Duke University. I will be spending this summer with 2 other Duke students in Leogane, Haiti! Why Haiti? Well…

Even before the earthquake that struck 5 months ago, Haiti was the poorest country in the Western Hemisphere. The coastal city of Leogane, where we will be going, was at the epicenter of the January 12^th earthquake. Approximately 80% of the city was destroyed. Most people are currently living in tent cities that have sprawled across the city. Many are without adequate shelter and with the official start of the 2010 Atlantic Hurricane Season yesterday, there is the threat of even further damage.

Knowing this, how can one say “no” to an opportunity to help out in Leogane? This will be a once in a lifetime opportunity not only to help out, but also to learn from people who have suffered more than I can even imagine.

So a little about our project - We are going as part of an organization, Family Health Ministries (FHM), which has been doing work in Haiti for 17 years. Our main project will be assessing the causes of maternal mortality in Leogane through verbal autopsies. This will hopefully lay the groundwork for interventions to help reduce maternal mortality in the community. We will also be working to update the GPS map of Leogane, created by students last year, by surveying what still remains post-earthquake.

4 days till we are in Haiti! I’m super excited!

Shilpa