Day one

Friday the 29th of August 2008

I was given a tour of the main orphanage when I arrived last night. I am staying at the guest house, which is on the same property that houses 90 children, under the age of three. I have one room mate, Stephanie, an American women who co-ordinates the orphanage's adoption programme. Our bedroom floor is tiled (easy to keep clean) and there are insect screens on the windows. We have our own toilet, a television and a DVD player and I am able to access wireless internet from my room. I am quite comfortable and very pleased with the staff quarters.

At the orphanage, Several "nannies" are responsible for the day-to-day care of the children in 4 nurseries that re located on the 1st floor of the baby house. The high care nursery is for neonates, sick and malnourished children. Children are grouped in the other rooms according to their ages and how far along they are in their development. The rooms are bright, airy and spotlessly clean. The children swoop in on you when you enter their room. They will cling to your legs, reach up to be held...and if you sit sown you wil not be able to get up...it will take two nannies to extricate a dozen toddlers from you.

There are few facilities for hand-washing, and no-where to isolate children with infectious diseases. Many of these little ones have diarrhoea. This is normal in Haiti. However, the storeroom, here, is full of donated baby care items and the staff do the best they can with what they have. They wash, dress and feed the children, and make sure they have appropriate toys and that they get plenty of fresh air. Unless they are sleeping, the little ones are on mats on the floor or in bumbo chairs.

***

Dixie Bickel, who founded and directs GLA with her husband had planned to introduce me to the project, the staff, and children, today. I was to meet with her to talk about what my role here will be over the next 6 months.

The Director, is, of course, a busy lady so I had to occupy myself until she was able to see me. That was not difficult! We usually have a full team of volunteers here, who work one-on-one with the children under 2 years old. There is no-one working in that role just now. With the help of nannies and the office staff, I identified some of the children who were most in need of "TLC" and took them out of their nurseries for a while. I was a bit concerned that I couldn't get eye-contact from some of the babies. They did warm up after a while, though, and responded well to the staff they knew. These are positive signs that the little ones are attached to their care-givers. It is very encouraging to see that in an orphanage environment.

At 10:30 in the morning, I was called to help in the High care nursery. A baby girl (lets call her Alicia) had developed a fever and seizures the night before. The nurses had put in an IV and Dixie had given Alicia steroids, IV antibiotics and fluids through the line. Alicia had suddenly stopped breathing when they had called me.

When I arrived Dixie, who an ITU nurse before she came to Haiti in the mid 1990's, was there with two of the Haitian nurses, and they were trying to resuscitate Alicia. Her chest sounded "gurgly", and we suctioned bile from her airway. It looks as though our baby had aspirated bile into her lungs. She was blue around the lips, floppy and did not respond when I stimulated her.

I learned that this beautiful little girl, with almond shaped eyes and elegant cheekbone was HIV positive and had been sickly ever since she had arrived at God's Littlest Angels. She was not on Anti-retroviral drugs because her CD4 count (the type of immune cells that the HIV virus destroys) was over 200. A count of 200 is when adults are considered to have full blown AIDS. However, children's counts run much higher, and their immune systems are severely compromised long before their count fall to 200. In the developed world, Alicia would have been started on anti-retrovirals long ago, but this is Haiti.

We worked on Alicia for 40 minutes. The solemn eyes of the nannies were on us, and all the while, visitors were coming in and out of the nursery. There is little privacy here.

To everyone's relief, Alicia began breathing on her own. I was asked to give her constant nursing care until she stabilized. The Haitian nurses were not comfortable with resuscitating this child. Children are not resuscitated in Haitian hospitals, therefore, the staff do not know how to give basic life support. I stroked the little girl's forehead and told her that her job was to rest, to use all her energy to get better, and we'd do the best we could to help her.

Alicia never regained consciousness. An hour and a half later, her breathing became shallow, her heart rate dropped and the left side of her chest became sunken. I started resuscitating her again, sent up a prayer and asked one of the nannies to call for Dixie.

The little girl's lung had collapsed. In Scotland we would have put in a chest tube to re-inflate the lung, but there are no chest tubes in this country.

20 minutes later, Alicia was making no effort to breath on her own. There were some tough decisions to be made. There are no life support machines in Haiti. Our baby was showing signs of brain damage, and there was nothing that could be done about it.

The Haitian administrator arrived. The child's mother had not visited for several years, and no one knew where she was. We stopped resuscitation, took out the tubes, switched off the monitor. I drew Alicia close to me, and told her we would all prefer if she stayed, but that it looked as though she was leaving us. 'Don't you worry about a thing baby. You are going to a better place. No one gets sick there, or sore or sad there.'

Alicia had a strong heart, which continued beating for a full 10 minutes after we stopped resucitating her. She would have lived had she fallen ill in Scotland, I don't doubt it.

In Africa, when a child was near death, the staff used to gather to pray over the little one, and sing to her. Others would hold her, rock her, tell her she was loved and that they hoped to see her again in Heaven. The Haitian staff didn't do any of these things.

They say that in Haiti behind the mountains, there are more Mountains. That certainly seems to be true. Similarly, I think that in Haiti, there is sorrow, so deep that you will never reach the bottom.

I suspect people see too many child deaths in this country. Madamn Bernard, the head nurse in the high care nursery, shook her head in despair. No-one wept or wailed in that room. Is this their professional reserve? Maybe. I get the feeling, that the staff protect themselves from grieving too strongly, the many many things they cannot change. 1 in 5 Haitian children never see their 5th birthdays. Alicia was one of them, just one.

Alicia's face was washed and she was dressed in a cream dress, with puffed sleeves. She was photographed; Dixie explained that this was necessary, to prove to any family members who might come, that the baby really did die.

There won't be a grieving rite. There isn't time; GLA provides direct care to almost 200 children. They are all in need of care and attention. An undertaker will be called, and Alicia will be laid to rest. Please pray for the staff, that God will give them strength and courage for their work. It is not easy.

Friday was a tough day, yet, I have seen and heard enough to know I have probably seen a lovelier side of Haiti, where people will do all they can with what they have, to save the life of a beautiful, but stricken child.

I have arrived

I arrived in Port-au-Prince on an overcast day, and so, the ocean mirrored the sky's light grey-blue hues, not the vivid Caribbean blue of tourist brochures. Some of Haiti's problems are clearly visible from the air. The bare earth and the rusty coloured inland waters are signs of deforestation and of landslides. I can well imagine that the floods caused by hurricane Gustav's onslaught over the past few days will have washed away a lot of precious top-soil, and polluted some of the fresh water sources with the blood of the land.

The moment I landed, I knew I was in a developing country. No question. The airport is a collection of rusted outbuildings, with a no-frills, concrete arrivals terminal. Stepping off the plane I was met by the moist heat – with temperatures in the high 80's and humidity in the 90's, the atmosphere wasn't sticky, it was wet. Inhaling, my nostrils filled with hot air, and the aroma of wood smoke. This was so familiar from my time in Africa that I felt I had come home.

The pass angers were inside the airport for over two hours, waiting for luggage that didn't arrive but 'would be on the next flight, due to arrive in 10 minutes.., the flight after that; 15 minutes... soon.' It was absolute chaos, in the unlit interior, sans air conditioning, with an increasing volume of luggage that had been destined for other cities, in other countries, and a growing swarm of travellers. Most of the people on the flights were Haitian nationals. Among them were a few missionaries, and a nun here an there. Next to me, there was a Brazilian man, who was with MINUSTA (the UN stabalisation mission). On the opposite side of the carousel, a UN peacekeeper in camouflage gear and blue helmet.

As far as I could see, there were no toilet facilities, and there certainly weren't any shops. Sweat was glistening on fore-heads, coursing down backs, and running down thighs.

I got through customs without issue, and was physically restrained on my way out of the airport by a set of Haitian hands on my trolley. He 'needed' my luggage. Forget it pal. He wanted my baggage tags. Why? And if you think you are getting the tag for the case that didn't arrive, you can think gain. After challenging the lean Haitian, who sighed theatrically and threw up his hands in despair, I did surrender the tag for the case I had with me.

Proceeding into the fenced yard, I was met by a porter, holding a sign with my name on it. Negotiating the trolley over the uneven ground, he led me to a secure paring lot, with high walls and gates. We were admitted by gatekeeper and past by rows and rows of 4-by-4's and SUV's. I was greeted by GLA's friendly driver, Ernst, James, the directors foster son, and an armed guard, who stood out in a smart tan uniform; his mission (and he chose to accept it) was to get me through the city safely.

After waiting another hour or so, for a lady who had been due in on my flight to meet her new son, a toddler she was adopting from GLA's orphanage, we set off across Port-au-prince.

I wish I could have taken pictures. I wasn't sure it was safe to be waving a digital camera around, so I didn't. I was wide-eyed with wonder. The poverty in the airport district is striking. The areas of Port-au-Prince we drove through were crumbling. Crumbling pavements, worn, pot-holed roads, eroded breeze-block walls. This though, is a vibrant city, with bright hand-painted shop fronts. 'VIP Unisex Salon', 'The superior institute of American English and Computing','Sipure water.'

We passed by slowly, in nose-to-tail trundling traffic, among battered vehicles. Some were without head lights, many had long since lost break lights, and indicator lights. This last issue though is minor, since no-one seems to use indicators. Horns are blasted frequently, though. If there is a high way code, or rules of any sort that govern how one behaves on Haitian roads, it was not apparent that day. Drivers give way if they feel so inclined, and if no-one gives way to you, you simply edge your vehicle in the direction you want to go in, and you go, even if that puts you in the way oncoming traffic. Ernst was, unflappably, and showed signs of being only mildly perturbed. From the state of the vehicles, it was clear there are a lot of accidents. One car had a splintered windscreen. There were a number of UN vehicles: mostly troop carriers, most not carrying troops. I saw only one, lone UN soldier paroling the streets. I get the feeling I may have seen a nicer side of the city.

The Haitian “Tap-Taps are a sight to behold. Most are modified pick- up trucks with camper van canopies. The back is kitted out with benches, and the vehicle bodies and canopies are painted in bright murals, and many religious slogans and bible verses.

As the line of traffic slowly snaked along, a moving panorama of Port-au-Prince played out across the windscreen and the vehicle widows. All along the route, vendors sold their wares. Fresh fruit, vegetables, and wooden crafts under tarpaulins. Across the street, paintings hanging on a breeze block wall. Cell-phone top-up cards in home made booths. New and used clothing hanging from trees. Some vendors walked up and down the rows of traffic, selling soft drinks and plantain chips. Rubbish lined the streets. Skeletal digs sniffed and the sweaty, sweltering, rotting heaps, and a teenage girl in a shapeless raggedy dress and bare feet sorted through it with a stick.

Women carried there loads on their heads, and they moved so gracefully that they almost seemed to float. There was a post Gustav rain shower, and many people were wearing shower caps and even bin bags over their heads; apparently, Haitians do not like getting wet!

Suddenly, the street widened and, buildings were profesionally built and meticulously maintained. The signs above the shops were commercially produced. There were parks with slides and swing sets for the children. We were in the suburb of Petion-ville. Our guard got out here, and we turned left up the Kenscoff mountain road. It was a winding twisting, bumpy road up to the orphanage. The rainy season has recently come to an end, so there is plenty of greenery. As we climbed, the temperature dropped a few degrees. There was a dip in the road, and then a big metal gate. With a honk of the horn, the gate was opened. We had arrived.

and...one more sleep

My flight to Haiti was cancelled today, due to high winds, driving rain and the threat of severe flooding.

My heart sank low in my chest when I got wind of the news. I only understood snatches of kreyol: this flight was canceled. All flights today were cancelled. This was a act of nature. And (in English), AA was not responsible; not for the cancellation and not for providing any sort of compensation.

The middle class Haitians, immaculately turned out, were indignant an furious. Those who were less well dressed in the flimsier, untailored garments were quieter. One stout man in a crisp business suit unleashed his fury on one of the company's ground staff, hands gesticulating and jowls shaking with rage. Standing apart from a swarm of travellers, who crowded the check-in desk, an elderly lady in a thin cotton dress and wide-brimmed straw hat dabbed at her eyes. She was lean, dry skin taut over her bony frame. She had a hospital name-band around her wrist. She was alone, but was soon attended to by a Haitian family.

American airlines get a big black mark next to their name for giving passengers the real run-around; despite their promises to arrange discount accommodation and reschedule flights, in the end, this came down to us. My global Sim card failed, and I couldn't get a line on any of the pay phones. As a result, I had to use my home SIM to make all the calls I needed to.....and suffer exorbitant roaming charges. Raaaaah!

Despite being sent on a wild goose chase by several AA/airport employees, though, I have managed to re-schedule my flight for tomorrow morning, and I have booked into a hotel- one that gave me the title "guest of the week", which, entitles me to a room upgrade, a mug and some mini chocolate bars. That was a good end to a bad day.

Unfortunately, in the midst of all the confusion earlier in the day, I lost my visitors visa. Eventually, I found a very nice immigration officer (I was not impressed by the bureaucracy and rude manner I experienced from immigration and customs staff yesterday.) Today's official, though, has reassured me I can still leave the country tomorrow. Thank goodness. Miami just isn't for me.

And I am very keen to move on, and to finally get to Haiti and meet everyone at GLA. Up until now, I had been looking forward to going, but I hadn't really felt excited. I'm glad I'm feeling it now.

One more sleep....

I am on my way, sitting in a Miami hotel room, following a safe Trans Atlantic flight that arrived shortly before air traffic control systems crashed across the USA!

I am a bit bemused by the cultural differences between the USA and Scotland; I'm not used to being called ma'am, and I am equally as unused to being finger printed - US immigration fingerprint all tourists now!

I am exhausted after being up for 22 hours but there is a lot to be thankful for. Everything has gone smoothly so far. I've got an overnight stop-over in a nice hotel, and most importantly, in a comfortable bed. I will arrive in Haiti well-fed and rested tomorrow, and clean. Yes, I took the opportunity for one last bubble bath tonight. I wont be having another for a very long time!

Please pray for my safety in Haiti, and also that I will adjust quickly to a different culture, and find my feet. I know people are praying all ready. If they were not, I would probably be beside myself with anxiety just now. I am feeling a range of emotions, but a calm has descended over me.

Please also pray for for the Haitians who have been affected by the region's most recent tropical storm. Haiti was pounded by hurricane Gusav today. The winds have died down for now, but there are fears that Gustav could return with vengeance. The full extent of the damage will be difficult to assess due to Haiti's limited infrastructure, but in the past, storms such as these have destroyed crops, torn apart the flimsy mud and grass homes the poorest people live in, and caused major flooding and landslides. This would be devastating for a country that is on the brink of starvation.
My next blog will be from Haiti. Until then, God Bless.

The Preparations Move Up a Gear.

I fly out to Haiti 2 weeks tomorrow. Every day, my nervousness and excitement builds. In the past two weeks, I have lost 2 nights sleep. There is so much to do, so little time to do it. So many unknowns about Haiti and God's Littlest Angels. What essentials will I be able to purchase there? What can I not afford to leave behind?

I have been preparing to go since Christmas: reading about Haiti: the health problems and health care, the security situation the language and the culture.

In January, I downloaded an e-book and audio track for adoptive parents. On almost Even Ground is a very accessible way to learn kreyòl words and phrases. I have no doubt they will take a lot of frustration out of communicating with the children and the Haitian staff at the orphanage. As I understand it, they speak very little English.

I have also been using a more formal study programme: Ann pale kreyòl. I have reached lesson 17 of 25 and will complete the remaining lessons while I am in Haiti. I hope I'll pick the language up quicker once I am immersed in it. The words are mostly French but the grammar is not. I find I get very tongue tied when I practice the dialogues. I believe the Haitian people are patient. Just as well!

Although I have some experience of providing health care in a developing country, which, I gained while I was at God's Golden Acre in South Africa, I have a lot to learn. I have purchased a good text book: A Manual of Tropical Pediatrics. I have been dipping into it and will continue to do so in Haiti.

So many books on my desk, so many thoughts in my head, so many goals and dreams, but 1 key motive: to be ready for the task ahead, so that I may fulfill it as well as I possibly can.

God's Littlest Angels

Where I am going

I leave for Haiti on August the 26th to join God's Littlest Angels (GLA). GLA is a child survival centre, high in the Kenscoff Mountains above Port-au-Prince. It is located in a wealthy community, but there is no piped water or mains electricity in the area. Instead, residents have water, cooking gas and fuel trucked up the mountain. Since this is an expensive exercise, all volunteers and visitors are charged for room and board for the duration of their stay. GLA have pre-warned me that both water and electricity are conserved on their properties. I can expect "military style showers" and have been asked to bring a torch, because the generators at the volunteers quarters are turned off at night.

What I Will be doing

Here is a preview:


The emphasis, as you can see, is on giving quality care to meet the particular needs of each baby and child. This fits well with my philosophy of delivering individualised, child-centred nursing care.

The director of God's Littlest angels, Dixie Bickel is a registered nurse with many years experience in Paediatric Intensive Care Units. I will be working alongside Dixie's Haitian staff at GLA's high care nursery, looking after premature and malnourished children, as well as children with other special medical needs: cleft lip and palate, cardiac conditions, burns, orthopaedic conditions, neurological problems HIV/AIDS and sickle cell disease, for example.

I will assess and treat children who become sick or injured, and will also play a part in routine child surveillance (monitoring growth and development).

I hope I will also have the opportunity to work one-on-one with some of these children. After all, that would truly fulfil my motivation for going to Haiti, which is to make a difference in the lives of a few children, in the time I have, in the place I will be.