Before the storm: Medika Mamba and mountain hikes

There’s a tropical storm, Emily, hours away from making landfall in Haiti. It could turn into a hurricane, so Canaan has been storing drinking water and positioning rain barrels and old oil drums to collect rainwater, and checking the cisterns for any leaks. 

I’ve taken clean water for granted. Water is a daily discussion at Canaan, and a few of the boys’ chore are solely to clean the water tanks and filter water for consumption. It’s a luxury to have drinkable water delivered straight to your faucets, or any water for that matter. In villages with a single well or water pump, women crowd with paint-crusted buckets and stained bleach jugs to catch precious drops, hauling them miles home on dry, fumy roads.

With all the work it takes, I am grateful for rain to fill our buckets for showers. And until then, I'm praying for the families living in the tents and shacks to weather the storm with ease.

Mamba is in full swing, and the past two days have been hectic with the missionary team and Mamba researchers from Georgia. I have sensed some of the Haitian mothers’ apprehension with the amount of Americans peeking in on exams, procedures and watching the rusty gears turn in our tiny rural clinic.

Each week, word of the Medika Mamba program spreads like pond ripples in the villages sprawling across Montrouis. I felt stressed as the new admissions to the malnourishment program crammed under the shade of sparse willows, packed in CESANOJE’s hallways and spilling into the consultation rooms.

We saw close to 50 patients and checked about 15 potential cases of malnourishment. I had my face between my knees with exhaustion in the heavy heat between patients, wondering how the mothers could bear waiting in the breezeless afternoon.

Some of the babies were shaking with hunger or thirst after waiting since 6 am for the consultation. One boy had a 104 fever and was crying feebly as I poured medicine down his throat, too weak to swallow.

It was difficult to feel enthusiastic when most of the babies seemed to be sick and loosing weight, or staying the same. Most of the babies graduate in six weeks or less, but out of all the enrolled babies, we had zero graduates Tuesday.

We did, however, readmit some of the children into the Mamba program— babies who graduated plump and vigorous 3 months ago, but now whittled back down to malnourishment.

Discouraging.

There’s a science to the Mamba. We can predict like clockwork—a well-researched bell curve—with how much weight babies should be gaining with proper feeding of the Medika Mamba. With my translator, Jennifer, I was able to demonstrate proper feeding (allowing small spoonfuls for the child to eat slowly, or mixing the thick Mamba with clean water) to help prevent vomiting with the babies. Many of the mothers had been force-feeding their child, and causing them to become ill and refuse the Mamba.

There were a couple patients who improved, and I did feel joy in giving mothers praise for their progress. Graduation from the program is a source of dignity and empowerment for the mothers as well—a contrast to the emotions of shame and avoidance we often see in those new to the program.

Malnourishment is as much disease as it is stigma.

Three women, public health researchers from Atlanta’s Moorhouse School of Medicine, interviewed mothers in the program to see if or how their breastfeeding habits changed when their malnourished babies were given Mamba to eat.

I’m really looking forward to their findings, although I was skeptical at first. Many of the babies are cared for by women other than the mothers, so we had to figure our which moms qualified for the study. In addition, many of the mothers had stopped lactating or stopped breastfeeding before the baby reached 6 months, when other foods can be introduced to supplement. This caused the malnourishment in the first place.

It’s awesome that Canaan will have a study that’s relevant and informative for others advocates of the Medika Mamba program to follow. I’m considering coming back for some research myself, focusing on the re-admissions to the Mamba program.

For the mobile Mamba clinic in Rousseau, I arrived with a nasty headache. I forgot my Excedrin at Canaan. One of the Haitian doctors, Dr. Guidson, saw me clutching my head and brought some migraine pills. I ended up sleeping, knees curled up to my nose, on a lopsided hospital bed while Caroline and Mis Joanne saw patients. With the tropical storm looming, many of the mothers stayed at home. My little power nap was magic, and I felt great around noon when the hospital closed, in time for the jarring drive back to Montrouis.

When Caroline and a couple visiting from Kansas City, Josh and Rachel, made our daily 2-hour hike up the mountains, we ran into groups of Haitians riding horses and carrying spades and shovels. A little girl followed us all the way back down, begging for candy and our (empty) water bottles.

A teenage boy attending English school in Montrouis asked me for my phone number, tagging behind me for the last 20-minute stretch of our hike. He was incredibly pushy, resolute and undeterred by my age. He’s the fifth Haitian male to ask me for my phone number, and wouldn’t accept no for an answer… even the fact that I don’t have a Haitian phone, and emptied my purse to prove it.

Perhaps it’s cultural for the men to approach a potential female interest with frustrating tenacity.

I can’t believe I have two weeks left in Haiti. Tonight I sat on the cistern at the top of Canaan’s hill—an enormous, panoramic view of Montrouis. It felt incredible to share prayers and stories with Americans conscious of Haiti’s needs and who share my love for this island. The team cooked cake and brownies for the Haitian staff, and we stayed late singing, playing guitar, and watching one of the babies, Marlucia, dance across the cafeteria table with every strum.

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.