This morning while Amanda, Christine, and Michelle went to serve in the clinic with our friends from Winchester in the riverside village of Fayette, Daisy and I were picked up by Taryn and Peter from Children’s Nutrition Program. This program has been operating in the mountain villages in the district of Leogane (apparently Leogane is both a city and its surrounding region) to promote nutritional health for children under 5 and family planning. They also operate a latrine project, installing sanitary outhouses in mountain villages – realizing that for children to be healthy and well-nourished, they need an environment free from contamination by human waste. The real heart and soul of this organization is the Monitrice program. Working with local communities, they identify a woman to serve as the monitrice for the area. This woman serves several key functions. She visits EVERY child under 5 in her villages and weighs and measures them at least once a month to screen for malnutrition. She helps to facilitate community health education, and particularly family planning – both during her home visits and at community gatherings. And she helps to scout for “positive deviance” in her villages. Positive deviance is a model for community nutrition health in which children who are healthy are identified and their mothers interviewed to learn how they manage to keep their children well nourished even with the lack of resources. Their contextual solutions to this problem are then shared with other mothers, in ways facilitated by the monitrice.
Before we headed up into the mountains, Daisy and I visited the referral center which is not far from FSIL (the Nursing School). This small relief tent serves as a place where 20-25 women with malnourished children come each day. Here they can be screened into the acute or moderate malnutrition feeding programs to begin receiving “plumpy nut,” the 500 calorie packet of nutrient enriched food that can dramatically turn around the health of a malnourished child (and it’s produced in Haiti). When we arrived, there was a one-month old girl (clearly underweight and -sized) who was suffering from bloody stool and a cut in her nose and had stopped breastfeeding. She was referred to Hospital St. Croix on the other side of town and we found out that she made it there later in the day. One of the things we learned today is that child malnutrition (age 0 to 5) has actually dramatically decreased in incidence in the past 5 years in the mountain areas, but not so in the flatlands of Leogane city and its surrounding areas. CNP continues to receive referrals of malnourished children in its Leogane center every day, but nearly all come from a low-lying area not a mountain village.
Next we headed off on the Darbonne road, into a river, and eventually up a mountain. When I say “into a river” I mean, the river WAS the road. Our 4-wheel drive was handy, and we were definitely creating wake as we drove the 20 minutes or so through the river. As the mountains came into view we could clearly see the effect of Haiti’s deforestation. Something like 95% of the Haitian forests have been cut down. The mountains we could see bore this out, with the only large trees on them being in the steepest crevasses between peaks where it was impossible for the tree-cutting to occur. As we ascended the mountains, the road grew narrow and the cliffs . . . well, we didn’t look down. Finally we reached the village where were visiting.
We climbed down a tiny trail a little ways in search of Regina, one of CNP’s 36 monitrices who is responsible for this and neighboring villages. We couldn’t quite remember where her home was so we just started calling out her name and soon enough she appeared and greeted us with her 16-month old son – who was lively and joyful. She welcomed us into her home – a three room hut with a cement floor, tin roof, and wood slatted walls. She washed our hands in the exact way the crucifer washes my hands at the altar every Sunday, by holding a basin and pouring water over my hands. Then she served us the best cup of hot chocolate I have ever had in my life! After some chit chat, we were off.
We spent the next several hours visiting many village families. Regina knew all the children in this village of 36 homes. The mothers were happy to receive her and the kids were weighed on her portable scale (it hangs from the nearest rafter by a rope). The children we saw there mostly were healthy and happy – several had been part of the malnutrition interventions of CNP when they were younger. School let out (around noon) and Regina saw them coming up the hill and corralled them all so she could measure the ones under 5. The older ones stood by to watch. We did wonder a bit about whether the older siblings (above 5 years old) were being suitably nourished, and continued to wonder about that as we learned that sometimes mothers split their “plumpynut” packets among all their children – which prevents the child in the program from gaining as much weight and health.
The last visit of the day was very difficult. We were checking on a child who has been acutely malnourished, was hospitalized, graduated from the program, became malnourished again and was hospitalized again . . . and then finally “healed out” of the program. When we arrived he was sitting on the floor of his two-room home with a plate of cornmeal and beans and a spoon, trying to feed himself. He is 14 months old, and so was having only modest success at getting the food into his mouth. The reason for this is that his mother, in her early 40s, was lying on the floor, looking incredibly sick – dehydrated, malnourished, and breathing laboriously. She was being cradled by her older neighbor who had come up from below and was resting against a wall, holding the mother in her arms like Mary held Jesus in Michaelangelo’s ‘La Pieta’ (I’m not joking . . . that’s what it looked like). She was feeding the mother her portion of the same meal with a spoon. It was heartbreaking.
Regina, our monitrice, got right to work. She squatted down and fed the boy all the food in his plate – shoveling it into him in heaping spoonfuls as fast as he would eat it. Then she washed him (he did NOT like this!) and weighed and measured him. Then she measured the other 4 children under age 5 in this family (there were 6 in all – ages 6, 5, 4, 3, 2 and 1). There was also a teenage girl who was the daughter of the father, but not this mother. She was mentally ill. None of the children were well clothed.
Our attention now turned to the mother. She was really sick. It turned out that she had hypertension and was receiving treatment. She’d been to a mobile clinic (not from St. Croix) and received blood pressure medication. But based on what we could discern about when she visited the clinic and how many pills she had left, she likely had been taking too much medication. She looked very weak and seemed to urgently need medical treatment. Though it was unclear how she would make it up the hill to our vehicle or take the 60 min. drive into Leogane, we offered transportation in our car. She declined because her husband was not home and there was no one to watch the kids. We managed to figure out which clinic dispensed the medication and Taryn, the CNP director, knows the medical director of that clinic. She said she would call him later that day and then call Regina and Peter (who is staying up there for a few days) with instructions. They may be able to send a car for her tomorrow – though CNP is not a medical organization (just nutrition and public health). We pray that she recovers.
We arrived back at FSIL around 2pm, just in time to welcome an unexpected visit from the Bishop of Haiti, who was in Leogane for a meeting at Hospital St. Croix and often stops by FSIL because he is proud of it. He was meeting with Dean Hilda, the head of the Hospital, a Haitian doctor who practiced in Boston for 40 years before returning to Haiti in retirement, and some other diocesan officials. They are trying to figure out how to improve the quality of Hospital St. Croix, though it’s not clear how easy that will be. I also met with Fr. Sonley, who is the Priest in Charge in Leogane. He has 9 parishes!
I apologize for how long this journal entry is. It is probably a reflection of the fact that there is so much to process about our time here, and yet our schedules haven’t quite allowed enough time for individual contemplation and reflection. I’ll end by saying that it seems to me that the challenge of this situation in Leogane is a bit of a chicken and egg problem. Haiti desperately needs to develop a functional, aspirational middle class. 100,000 Haitians hold 99% of the wealth in this country . . . and the other 11 million people hold 1%. For there to be a functioning middle class to which people can aspire, there needs to be infrastructure (stable power, roads, clean water, health care, etc.). But for these things to become reliable, there needs to be a middle class that is politically empowered to demand them, and then has the knowledge and resources to build the infrastructure they seek. One ray of hope in this challenge is FSIL. What Dean Hilda and the others are building here is a community of young women and men who aspire to become the Haitian middle class – empowered by knowledge of a skilled profession, the discipline to practice it well, and the self-respect and compassion to put that skill in the service of others. Competent nursing may be the structure, but empowerment to desire and attain a middle class existence in Haiti is at the heart of what FSIL is producing for the future of this country.