Haitian parenting, gender roles and the story of dimples

Since noon, a tropical storm has perched its horrible, languid self over Montrouis and buried Canaan in somber grey. It’s the kind of idle day I long for at home. Staying indoors, reading, taking naps. But in Haiti, it’s miserable not being able to get out and explore.

Especially when it’s Friday when work is finished, and the beach is a 15-minute walk down a mountain.

Since beach-destined paperbacks and my iPod’s indie rock genre were re-routed to my bunk bed and absorbed most of today’s boredom shockwaves, I’ll share a few things I’ve been saving up.

Last week, we drove a mother and her 8 mo. old daughter to St. Marc for an X-ray. Tired bodies crushed together in the truck, cramped with our mobile Mamba clinic supplies.

Haitians stuck out their thumbs like hitchhikers or waved at us with both arms as we passed, asking for a ride in the empty truck bed. Younger children jumped in as it bumped along, some naked and careless and not bothering with any gestured formality.

The young mother breastfed her daughter and shielded her baby’s eyes while the truck lurched up and down the mountainside. After working the Mamba clinic for the past two weeks and seeing so many young mothers or female caretakers detached from their children, I was struck by the tenderness of the gesture. Cradling the tiny girl’s head under her breast, clucking softly to the baby, and of course the willingness to cram herself in the truck alongside strangers to drive to a far-off hospital, seemed almost beyond the call of duty for the typical mother.

Affection is often treated like it's impractical.

My first week here, Elsie told me a “good” mother provides enough food for her children to live without starving; that’s all that’s required to meet that guideline. I refused to believe that can be true, at least not entirely.

She told me a story about a young missionary woman who went to the beach and saw a Haitian toddler alone. She played with the child while the parents watched not far away. When it was time for the missionary to leave, the parents emerged and, seeing the young woman absolutely adored the child, put the baby back into her arms and asked her to “keep.” Shocked, the young missionary refused.

However, the next morning, the parents arrived at Canaan with the child dressed neatly in her best clothes, clean and perfumed, to ask the missionary to, please, take their child. For real. To keep. The parents had discussed it seriously all night and decided they wanted to give their baby to the missionary. They did not love the girl, and knew she would be better off with someone who did. Once again, the missionary refused – she couldn’t just put a baby in her carry-on back to the states – but Elsie said it was a lesson in Haitian parenting.

Detachment is a survival mechanism. Show someone else’s baby love, she warned, and they might just try to give their child away.

But there are exceptions for everything.

Single mothers make up the bulk of Haitian family units from my experience in Montrouis. Women of some relation raise the children, commonly older daughters or grandmothers, while the mothers are at the market during the day, bartering and selling. Fathers are absent from the picture, some working their cattle under the banana trees, some in odd-jobs in Port-au-Prince, while the kids grow up.

The women at Canaan hired to take care of the babies at the nursery are my age. Early 20s. No experience with children. Yet they’re living like many Haitian women that age— 24/7 single moms.

It’s been rare from my experience so far, but there are some fathers actively raising and loving on their children. For example, every week, this adorable Haitian dad proudly totes his all-pink bundle of a 5 mo. old girl. The baby’s mother died shortly after giving birth of infection. Malnourished and sick, she was enrolled in the milk program at CESANOJE – open to infants under 6 months who do not qualify for the peanut-butter based Mamba. This dad, however, took all responsibility of child rearing. The baby’s finally alert and putting some chub on her little cheeks, only months ago hollowed with starvation.

Most of the “orphaned” children at Canaan are actually just motherless. Many have fathers or older siblings that live in Montrouis and the surrounding towns. But without a mother, the family unit crumbles. Just this week, a father asked us to take his little boy and presented us with his mother’s death certificate.

Dead mothers make orphans. Dead fathers make hungrier bellies.

Working at Canaan, I’ve noticed distinct gender roles. The men are laborers, in charge of maintenance and construction around the orphanage, clinic and school. The women do the cooking, the cleaning, and all the laundry. None of the men here do their own laundry, not even the boys in the orphanage – the girls inherit that chore. Ironically, the women at Canaan hold the powerful leadership positions when it comes to leading incoming missionary groups and negotiating donations with non-profit relief agencies.

Even the clothes here are gendered. Men wear pants and jeans, while women wear dresses and skirts paired with Ts and the occasional tank top. Some of the bolder 20-somethings wear tight Capri pants. I’ve never see shorts, except on hairy white legs of missionary men and on young girls chasing through slums of Port-au-Prince’s.

Just yesterday, Doctor Jean Robert and I were sipping our black coffee after breakfast, when we received a call. Without a goodbye, he shoved his dirty dishes in my direction and walked off, leaving me fuming. Was he handing me his dirty dishes because I was a woman? Everyone took care of their own dishes and did their own washing, and I pointed this out to the doctor later that day. He seemed unruffled, and I decided to resign myself to cultural norms. If I didn’t pick up his dirty dishes, one of the overworked Haitian women would have to do it.

Doesn’t make it any easier to swallow without resentment.

The gender distinction is particularly interesting when Caroline and I are on Mamba duties. Two white woman driving through town to pick up food is met by laughing men, partly in surprise and more in rude amusement, following us in a herd as we load up the 50 lb sacks of white Texas rice and pinto beans. Women, in our festive skirts and poker faces, carrying our heavy loads to the truck bed while they shake their heads and grin as if to tell us, this ain’t no women’s work.

Cute Haitian Folklore: The Origin of Dimples

The Haitian doctor working at CESANOJE (nickname for Canaan’s community clinic, Center de Santé Nouvelle Jerusalem), shared with me some cute folklore: The story of dimples.

When Haitians talk about dimples, they also point to their lower backs, where the spine curves into the buttocks.

To get dimples, a mother has to push her fingers hard into her baby’s cheeks and lower back during those formative days. Then, voila! Dimples. If someone doesn’t have dimples, their mother either didn’t take an active role in the dimple making, or push hard enough.

Every time I see a Haitian with dimples, I can’t help but smile and imagine a mother’s fingers prodding the cheerful indentions.

Mango guts, melon cores and chunky Mamba thighs

Posing with the fruit purchases... so happy!

Mangos smell rich and womanly under their soft yellow skins, sweet and steamy and damp like fresh mountain rain. Their perfume mesmerized me as I zigzagged through Montrouis’ open market, skirts swishing as women bargained and young boys begged, their hands held open like empty prayers.

After dulling my palate with two weeks of rice, pasta and white bread, the flavor almost choked me. There’s something embarrassingly sensual about biting into a mango, tearing the skin with your teeth. Juices dripped down my chin, and I felt like a child. Or a vampire, sucking zealously on raw flesh.

The texture of a mango is similar to a fine pâté once you get past the stringy bits near the skin. The hard core is a palm-sized heart, emerging from the goopy fruit almost alive, like the trembling meat in an oyster shell. I saw children sucking on the mango hearts like lollypops, leaving the cores smooth and brown.

I had never peeled a mango before, and some of the younger Canaan girls laughed as my fingers clumsily stripped the fruit to keep the precious orange heartstrings intact. The 12-year-old, Marceline, took the mango from me and stripped it meticulously with a knife, peeling it like a sweet potato. Under the swaying tungsten kitchen lights, the naked mango looked and felt like a slimy fist of raw chicken.

Our purchases from the market, minus a couple of mangos we couldn't wait to devour.

Caroline, the full-time director of the Medika Mamba malnutrition program in Montrouis arrived back at Canaan this week from a month-long hiatus. She picked up Creole after only four months mission work thanks to her background in French. I would have been lost without her navigation through the Montrouis fruit venders.

The key, Caroline said, was to play the vendors against one another and let them compete for business. We drove the Mamba truck to the middle of Montrouis to exchange USD for goudes. A bare-chested Haitian man lazily flicked at flies as he did the transaction: 800 goudes for $20 (40 goudes for every dollar).

The market starts on the curb of the winding highway of down-town Montrouis and extends a hair's length from honking tap taps or gestures of high-speed passers-by, filling the market with a stench of diesel. Haiti's Rte 1 cuts through the market's bustle, while a tangle of merchants with massive bowls or cracked tupperware aggressively wander like auctioneers. The more relaxed of the vendors sit under lopsided shelters, displaying everything from glass-bottled beverages to raw meat dizzy with flies.

As soon as we had money, women with huge bowls of melons, avocados, limes, mangos and spiky green and brown fruits I’ve never seen before swamped us. Unable to negotiate in the chaos, with fruits thrust under our noses and rubbed against our skin amid yells of “bon bagay!” (meaning, “good thing!” in Creole), we climbed in the truck and rolled down one of the windows. Caroline bargained ruthlessly, chastising the women as they advertised their wares at twice the street value to us blancs.

When we finally agreed on a fair price, the rapidly truck filled with fruit:

For $5 (US), we bought 13 plump, healthy avocados, picked that morning just miles down the road.

For $1, a handful of fragrant limes. For $2.50 a piece, two swollen and aromatic melons.

For $5, a bucket of mangos, warm from the afternoon sun, that made us drunk and salivating from sweetness.

Total price: $16 US, and we watched as two of the women strutted back home, finally selling all their goods after a long day at the market.

Caroline, Amy, Robin and I devoured the fruit, speaking only with “mmm”s and “ahhh”s.

The avocados need a few days to ripen, but with some garlic, lime juice, salt and pepper, we plan to make guacamole to eat on chips that a missionary team is bringing for us Saturday, per Caroline’s request. We prepared a fruit salad with the mangos and melon, juices marrying in a ceramic mixing bowl and nestled in one of Canaan’s industrial-sized refrigerators. I hope we can stretch it out over all our meals tomorrow, but we put such a dent in the mangos we might be back at market tomorrow.

Today was incredibly fulfilling, in addition to belly-filling. Canaan operates on routine, and I’ve fallen into the predictable cadence as I start my third week in Haiti. Wednesday means Medika Mamba at Rousseau, the rural hospital in the mountains. 

We had quite a few babies graduate from the peanut-butter based malnutrition program today at Rousseau, and Montrouis Tuesday. I love seeing emaciated babies transformed into giggling bundles of meaty arms and chunky thighs. We document these transformations with photographs, and the difference is astounding.

Graduation from the Medika Mamba program is the difference between shriveled, stunted bodies and those healthy rolls that make me smile. It’s death conquered by vitamins, protein and crucial calories.

Women and babies line up for Mamba assessments at Rousseau Hospital.

Twins get undressed to be weighed and examined.

I am exhausted, though. Caroline led us on a 2-hour hike into the mountains. My sweat glands were on overdrive as we climbed the steep rocky path. Like most afternoons, the air felt smarmy and damp and made my glasses slip incessantly down my nose. Out of nowhere, the mountains in the northeast echoed with thunder, and my sweat mingled with dense raindrops.

It’s so peaceful here, watching lightning blaze in the mountains while the coast is serene, untouched blue.

Haitian hospitals, Medicine food and Creole lessons

Child with Kwashiorkor symptoms.

It has been a week and a day since I arrived in Haiti, but it feels like longer. There was a funeral at Canaan for a man of Montrouis, and I have part of the tune stuck in my head. It reminded me of a New Orleans jazz funeral –- several trumpets and a trombone player played a lively waltz rather than a somber melody. It was a colorful affair, which I peeked at through the steel-barred clinic windows.

I had my first Creole lesson today! Pastor Joelle’s wife taught us the Creole Alfabét, which is almost exactly the same as French, and some basic classroom vocabulary for the women working as English teachers.

Here are a few works of the day that will be useful for the clinic, especially when directing patients to their place while taking vitals:

Chita (la) = sit (here)

(Pa) kanpé la  = (don’t) stand here

Sòti  = go out

Rantré/ antré = come in

My morning was rather monotonous. Katie and I resumed cleaning the clinic storage room and sorting supplies that we think need to be donated to the local hospitals. I’ll be typing the list for Sister Gladys this weekend.

We had to put a lot of supplies in a trash pile for being either trampled in the chaos, covered in dust or bug bits, and some once-sterile containers chewed through by rats. It was also frustrating to see so many surgical supplies YEARS past the expiration date, thrown messily in rotting boxes. It’s fantastic that American medical supply companies are donating to Haiti, but medicines and wound prep kits “good until 2001” aren’t ideal.

View of the mountains through the Mamba truck window, on our way to Rousseau Hospital.

We sang along to Adele from my iPod Touch until our feet were gray from shuffling around in dust.

Here’s my reflection of the day: Why in the world would a rural primary care clinic need Foley catheters, sterile bone saws with leg amputation bags and around 1,000 surgical gowns? It may be a dream down the road to offer care in emergency situations, but for now Canaan doesn’t have the resources (or the space!) to store these supplies. They need to go where there’s a pressing need or them, like the hospitals in Pierre Payan, St. Marc and Rousseau, with specialty doctors on staff to address these needs. Otherwise they’ll end up like the pile we trashed—dirty, rat-eaten and unusable.

Yesterday I woke up with nausea and abdominal pain. I had to sit with my head between my knees so I wouldn’t start dry heaving at breakfast. The change in diet has disrupted my digestion, but who knows exactly what set it off. However, it was a busy day and I had no time to take it easy.

Doctor Jean Robert prescribed me some medication that the pharmacist, Henry, only gave me after teasing me in drawling French. Katie and I, along with Mis Elise and a translator from Canaan, hurriedly loaded the Mamba truck and drove 45 min to Rousseau, a hospital and health center deeper into the mountains than Montrouis.

It was the bumpiest drive I’ve ever been on. We passed a thick river, with naked children washing laundry and stretching linens to dry over skull-white stones. With their thumbs out like hitchhikers, people from Montrouis hailed us to stop so they could jump in the bed and catch a ride along the steep road.

The hospital was nice, but crammed with people waiting for consultations. We set up the Mamba supplies as mothers and grandmothers lined up on a crooked bench. Some of the children were so malnourished that their ages were indiscernible. A mother brought her 5-year-old son, smaller than the 2-year-old I babysit back home. He weighed a shocking 11 kg. An 8-year-old girl weighed only 14 kg, but could not be admitted into the Mamba program because of her age. The nurse gave her bags of rice. We also gave every family we saw to large bags of dehydrated soup – aid for parents as shriveled as their sick babies.

Here, food is medicine.

Rousseau Hospital. My camera was fogging up all day.

We admitted a new baby into the program that had severe edema (swelling) of his legs and belly. The edema is a symptom of Kwashiorkor, a form of malnutrition when the diet doesn't provide enough protein. He looked like a cartoon, his skin suctioned to his rib cage, while his legs and belly swelled like balloons. He was burning up with fever, but we were out of antibiotics. It was horrible feeling to let him leave without proper medication. 

We finished the Rousseau Mamba consultations at noon. After a quick lunch at Canaan, Katie and I drove one of the young mothers and her sick 6 mo. old baby to the hospital in St. Marc for a chest X-ray. A doctor living in the states who serves Canaan in his spare time agreed to take on the baby as a patient. She has strange dimples in her chest, as if her rib cage has been pushed too far back. There’s strangeness in the way it juts, and the baby sounds like she has pneumonia or some kind of lung infection.We didn't have to wait too long for the X-ray, and there were no lead coats for protection. I stepped outside to put a cement wall between my body and the radiation.

I saw my first Emergency Room in Haiti at the St. Marc hospital. It was a large room, smaller than a waiting room from one of the hospitals I work at in Baton Rouge. Mismatched beds were squeezed together like an infirmary. The room was hot and still, except for a single ceiling fan. I can't imagine laying in that stagnant heat for treatment.

I was exhausted and still felt sick after the long day. After dinner, I fell immediately asleep and did not wake up until 6 am this morning: 11 hours, through the generator being turned on and off, without moving. I’m feeling better, but the pain comes and goes.