Last night's dinner meeting...

Last night I had my final wrap-up meeting with pcH.  They took me to a cute little seafood restaurant in Petionville to discuss my month.  I was struck by how grateful they are that I am here, and I tried in every way possible to return that gratitude.

As we discussed my upcoming proposal, their wheels started churning.  pcH does not have a health care arm.  At first they suggested that I might be better off partnering with AME-SADA.  When we discussed that SADA does not have any involvement with the community, they agreed that their values are more in line with the type of program that I would like to build.  They then suggested that they might need to review their founding documents.  Their contract with the Haitian government states that they are an NGO that works in cooperatives, agriculture and adult literacy.  First they will speak with their board, then their lawyer, and then they may need to apply to modify their government documents.  They sounded very willing to do so but warned me that it might take some time.  I encouraged them to take as much time as they need, reminded them how impressed I am with their organization, and explained that I hope to work with them for many years to come.  We agreed that if the government won’t let me start a health program by the time I come back in August, then they will help me work on language skills and learning more about Haitian culture (and they might have me teach some English classes).

And then I opened up my line of questioning.  We discussed how health promoters might be selected.  Their communities already have health agents, midwives, and voodoo priests, all of whom practice some form of medicine.  However, I would like to use a term different from health agent, potentially health promoter, but we’ll discuss that with the communities.  Then we will ask the cooperatives.  I’ll explain to them what a health promoter will do, and then their community, through open space dialogue, can come up with their own list of qualities their health promoter should have.  After the list is generated, we will ask them all to vote on whom their promoters will be.

We also clarified that based on Haitian laws health promoters here will never be allowed to prescribe medicines.  Ironically, you can buy antibiotics, antivirals, and birth control pills in any market place, or even on the bus, but they won’t be allowed to write prescriptions… However, I reassured them that there are many many things that they will be able to do without prescribing, such as suturing, teaching how to make oral rehydration solution, and healing without medicines.  They got really excited and LeGran said, “They will save lives!” (His words, not mine J, but that is the idea.)

My language skills also need some help.  We agreed that I should have a helper, who I will call a partner.  I asked them to look for a few smart dynamic villagers who speak both English and Creole, who I can then interview.  I reassured them that they need no health care knowledge and they don’t need to be certified translators.  My ideal partner would be fun, animated, willing to try new things and culturally sensitive.  I explained that I need a local person to help me with Creole, but I also need someone who will elbow me if I say something that’s not culturally appropriate. (They agreed.) My proposal will include a stipend to pay this person, and a similar stipend to pay myself.  (I’ll donate it back, but that way they can financially account for my services.)

We also discussed about when, in the future (when my schedule isn’t based on a residency program), it will be best for me to come back, i.e. one week every two months, two weeks every four months… And they proposed that I come between planting an harvesting.  Ideally 2 weeks in January, 2 weeks in August, and 2 weeks between November and December.  I’m not sure how that spacing will fly with my future employer, but agriculturally, that makes a lot of sense.

Our meeting concluded with another round of appreciation.  They appreciate me, love my ideas, believe that our philosophies are consistent and are honored that I want to know Haiti.  I reiterated why I’m impressed with pcH, thanked them for their hospitality and generosity and told them how excited I am about coming back.

The best part, of the meeting though, was when LeGrand decided that since I keep coming back to see Haiti, Haiti and I have become lovers.  I made them promise not to tell my boyfriend.  J

Animation in Haiti-- a development model

I’ve been reading this paper, Animation in Haiti: MCC Haiti’s Experience with Rural Community Development by Barry C. Bartel, published in February 1989.  Barry lived in Haiti for a few years during the 1980’s as an MCC volunteer (it’s something like JVC, but through the Mennonites), and his writing is eloquent, as I wish mine were.  I’ve transcribed the first section of his paper, as I think it’s brilliant…  It might be a little too philosophical for some of you, but I think it resonates so well with everything I’m trying to do.

(Hopefully he won’t mind… I don’t have any permission to replicate his work, but I hope he’ll see this as a sincere form of flattery.  J )

Animation as a Philosophy of Development

Before describing animation in its specific applications to Haiti, it is important to establish it as an overall approach to or philosophy of development.  The specific applications will then be seen to embody this philosophy.

The term animation is not likely a familiar term in many development circles outside of Haiti.  Other terms, such as consciousness-raising education, participatory development and empowering, may be more familiar in other countries.  The essence of the approach is that it sees development as a long-term process that seems to empower others through encouraging and facilitating their participation and ownership in the development process.  Results are important but are secondary to the process.  Roland Bunch, author of Two Ears of Corn, has identified a key to development not as solving or even helping people solve their problems, but as helping them learn not to solve their problems.  Otherwise, what happens if we help them solve their problem, then we leave, and their problems change?  They are stuck, no better off than before we came.

Haiti is the poorest country in the Western Hemisphere and by some people’s estimates has the highest concentration of foreign missionaries in the world.  Foreigners see needs in Haiti and feel good doing things to solve them.  Haitians thus learn that the only way for their situation to improve is if foreigners come and do something for them.  I call it the Helpless Haitian/ Almighty American syndrome.  As a result one of the biggest tasks for development in Haiti is to help Haitians learn that they can control their situation and solve their problems.  Without a doubt they need technical advice, moral support, and financial assistance, but they need to own the solution.  This takes longer and results may not be as evident, but some of the most significant results (trust, cooperation, a sense of individual and collective self-worth) may be invisiblt or may only be a seed then we see them.

In its orientation sessions for new workers, MCC stresses that new workers will likely enter assignments with high expectation of what they will accomplish.  They desperately want to help those less fortunate than themselves.  But the brief contributions of development workers are often more frustrating than productive, as is seen as a long-term enabling process, the approach is significantly different than when participants try to produce visible results quickly.

This approach takes more time, but hopefully results are more permanent.  Rather than solving someone’s problem, an approach based on animation helps people identify their needs, helps them identify and analyze possible solutions, helps them develop and implement a plan, and only then helps them find necessary financial resources to supplement their own resources and work.  With their own planning, work, and sacrifice, they will own the solution, begin to feel like they can solve their own problems, and work to ensure that the solution lasts.  Without this emphasis on process, we risk showing people that they can’t solve their own problems now or when we leave.  Animation as used in Haiti does an amazing job of bringing primarily illiterate farmers, who have learned by living that life is difficult, that leaders dictate, and that foreigners are needed in order for anything good to happen, to an understanding and implementation of forms of cooperation, solidarity, collective self-worth, and self-determination.  The process is the key.

This is the shortest section of this paper, but I believe is is the most critical.  I articulate it here because I believe it forms the foundation on which specific applications of animation in Haiti are based, not because I expect it will be new or revealing to people reading this paper.  I suspect the above description of philosophy would have been more universal application in development than the specific approaches used in Haiti, though they, too, may have application elsewhere.

Amazingly Powerful Painting

Reflections after a weekend in Jacmel

Hey all!
     I just got back from a great weekend in Jacmel with Dom and his friends, Nesly and Natalie.  We drove past some incredible earthquake devastation on the way out, and Jacmel was a breath of fresh air on the other side of the mountains.  They have their share of quake damage too, but it's hard to shake the beach.  We drank Prestige, swam, and ate freshly caught fish under the palm trees.

Here's the dining area.

Nesly and Natalie

Dom learned to back float.

Sun setting... love the clouds

     Today we hung out at Leslie's house while Dom's car got washed and detailed, and then we drove back through new devastation.  The heavy rains last night flooded many of the main roads to Port-au-Prince and washed piles of trash all over the place.  We actually had to turn around at one "puddle" and find an alternate route.

Here's where we turned around

Going to Jacmel was great fun and an opportunity to reflect. 

Having been in Haiti for approximately three months of my life, I have nothing tangible to show for it.  It’s an interesting feeling.  The medical mission group who is staying at Wall’s saw 976 patients the other day (with a total of 8 doctors, in one day… that’s scary).   Another group built an orphanage.  Yup, they got their hands dirty.  Me, I’ve just learned a lot.

I first came to Haiti on immersion experiences, to see poverty and learn about the world.  Those experiences served as social justice retreats and powerful motivators.  In medical school, I came for a more spiritual retreat, to hang out on Jane Wynne’s organic farm and make recycled paper products.   I came last fall to learn Creole and to meet with nonprofits about long-term partnering, and here I am again.

Well, this trip, I’ve taken steps toward long term partnering.  Studying the rural medical system, learning more Creole, and having some fun are perks, but I think the relationships that I’m building are most significant.  Already committed to working here, I need to make sure that whatever I do is effective.  I’m making a big investment of my time and resources, and I’m expecting to see real returns someday.

I’ve fallen in love with participatory development, and I’m really looking forward to partnering with PCH.  They’re effective, and they’ve proven it again and again.  If I can assist them in adding a health care arm that is similarly empowering, while simultaneously saving lives, then all of my time will be well spent.

Thanks to all of you for your patience and support!  I'm so grateful.
love, becky

Pictures from Fond Baptists

Flag Day Parade

School kids

Watching a soccer game

My friend Miguel (in the green) helping at a mobile clinic

Love those chubby, well-nourished breastfed babies!

Soccer

Farm boy

Miguel, Parish Twinning and Rising Above Poverty

Miguel is pretty remarkable.  He’s smart student who speaks Creole and French and understands quite a bit of English.  But even more remarkable, he’s not married, he has no children, and he’s twenty.  Wow.  He’s charming and attractive, and he doesn’t even have a girlfriend…  that doesn’t happen in Haiti.

So, what made this possible?  What gave him the confidence to pursue his education, and what let his family allow him to do that?  After all, he should be working in a field somewhere, building a family, and being a productive person.

He lives in a parish with a twin/partner in the states.  He goes to a church-based school.  We can credit his language skills to his education, which likely has roots in that twinning relationship.  But there are twin parishes all over the place here through a billion different NGOs, and most twenty year-olds are still done with school.  I’ve learned that school is a potential starting point, but it doesn’t hold the answers.  That’s not where I put my money, my investment dollars, or even my time.

Miguel’s overall success in life really is due to his family’s stability.  Fond Baptiste has a productive cooperative.  His family is economically stable.  They can let him finish school, they value his education because they see how it will help them all, and they encourage him to wait to have a family because they see hope for his future. 

Kids all over this country go to church-based schools, but if their families are not stable and their communities can’t see a future for in their education… Schools aren’t the answer.  Churches aren’t the answer.  Economic development and community building are.

          I’ll go one step further, and then I’ll get off my soap box.  There is a ridiculous amount of money coming into Haiti every day.  People are bringing everything from beanie babies to life-saving medications.  Many organizations have been doing this for years and years providing all variations of handouts.  As my friend, Colleen, said tonight, there’s nothing more demeaning that repeatedly asking someone, “What do you need?”  To truly partner with someone you need to live with them, work with them, and ask them how they do things.  Haitians have been surviving, against all odds, for much longer than they technically should have.  We need to recognize their strengths and empower them to stand up with outstretched empty hands.  Only then will we start to learn.  And I’m just starting myself… 

Fond Baptiste

As many of you may know, I spent the last week in Fond Baptiste.  What a breath of fresh air.  I am delighted to say that some areas of Haiti work.  (I find it interesting that the employees of PCH (all Haitian) have observed that the communities which are further from “blan influence” work harder, which appears to be true of Fond Baptiste.)

          Fond Baptiste is about 2 hours of bumpy-rocky road from the main highway.  It’s beautiful, green and cool.  Claudio (a Chilean journalist, theologian, philosopher, photographer, and former professional soccer player) and I got to stay with a fairly well-off family.  We still haven’t figured out the family structure exactly, but there are five people living in the house.  One is a nurse, whose kids are grown and whose husband works in New Jersey.  Another is an old man, Odny, and I have no idea how he’s connected.  I’m still not sure which of many other people actually live there. 

They have a live-in cook and two restaveks.  Restaveks walk the line between slaves and adopted family members.  Families who can’t afford to feed their children often give them to rich families with the hopes that they’ll feed and raise them.  Sometimes that happens, other times unthinkable abuses occur.  But these two, both around 12 years old, are happy and healthy, and one boy gets to go to school.  Frankly, I’m sure there are just as many evils with the restavek system as there are in the international adoption system, and I’m not sure which is better.

Tuesday the folks from SADA showed up to tell me that I had the day off.  Apparently they didn’t have any room for me in their truck, but they said they’d come back for me the next day.  So I bumped into some neighborhood young people and asked them if there were any Flag Day festivities.  We walked down to the parade together, and I got a tour of Fond Baptiste en route.  After the parades we came back and played Dominoes, for a few hours.  That night, when the nurse got home, we had “class” where we went through my Creole-English medical dictionary and pointed to body parts and joked about anatomy.

Wednesday and Thursday I worked with two different nurses at the mobile clinic.  These nurses were actually seeing patients and writing prescriptions.  They used the same methodologies as the doctors, iron for fatigue, ibuprofen for pain, antibiotics for cold symptoms, and anything they didn’t know what to do with, they sent to the doctor’s station.  By Thursday, my Creole had gotten good enough that the nurse I was working with actually started asking my opinion.  For example, we had one patient with a big sebaceous cyst, which was already coming to a head.  He wanted the guy to go to a hospital for surgery (they don’t I&D in the field).  I recommended that he try warm compresses a few times a day for a week, and then come back to the mobile clinic next week if it hasn’t popped.  The nurse then gave him antibiotics and ibuprofen for good measure.  He also let me counsel some patients in Creole, on avoiding salt and caffeine with hypertension and things to eat more of with anemia.  I think the patients were as amused as I was to hear me explaining things.

           Coming back to Port-au-Prince last night was like a homecoming.  I hugged Betsy, Veniel and Katherine and all of my Walls family.  I checked my emails (I had 196), chatted with Gary, Stef and Heather Borek, relaxed and went to bed early.  This morning I celebrated by jump roping for thirty minutes and enjoying a non-bucket-bath shower.  Life is good, and I promise I’ll have deeper reflections to come.

Weekend at the Beach

     We spent the weekend at Club Indigo, a gorgeous Haitian resort.  Not that I've been suffering, but it was great to get out.  The club was simple, beautiful and absolutely luxurious.

Our group at Club Indigo

(formerly Club Med)

Veniel & Velanda

View from the lunch table

Playing with Venaika in the sand

What a great day

Are we really investing in communities?

            Yesterday was a great clinic day. I spent a second day working with Dr. Pierre, who speaks no English, but is good enough to repeat complicated words for me and even write them down.  She started asking me clinical questions, what would be my diagnosis of this situation.  Interestingly, her differential diagnoses are pretty slim.  A patient who presents for fatigue without fever is automatically diagnosed with nutritional anemia, after all her diet is probably poor.  Despite that many “field lab tests” available for checking hematocrits (ranging from spinning tubes which require electricity to simply comparing a spot of blood to standard color ranges), this clinic makes the diagnosis presumptively. 

           

            We saw this beautiful smiling baby in consultation.  Mom started talking about how she was sick, and the doctor took the baby, started playing, and reassured mom that she was fine.  (Apparently, mom really brought the baby in for the free sandwich.)  We each played with her for a bit and gave her back to mom, who then got her sandwich.  Then mom came back a little later, handed me a sleeping baby and ran off to do errands.  Yikes!  My first question was, “Eske ou pral returne, wi?”  (You’re coming back, right!?!?)  For all the talk of abandoning children around here, I had a right to be worried… 

            I think it’s really fascinating how much effort foreigners put into building and maintaining “orphanages” (a term which disturbs me greatly, because they have parents!).  Don’t get me wrong, I believe that children should be loved, schooled and fed, but wouldn’t it be nice if they could do that while living with their own families.  Haitian mothers and fathers love their children, just like we all do.  And I find it absolutely depressing that some of them feel so desperate that they feel the need to give their children away, thinking someone else can do it better.

            Fortunately, economically viable communities don’t need orphanages.  Communities that produce allow parents to raise their own children.  Wouldn’t it make more sense to invest all of that money into capacity building and training programs so that families could stay together?

            Needless to say, mom came back.  Her community, though it still has a few cases of malnutrition and struggles with various social problems, has a cooperative.  They have worked with PCH for a long time.  The people of Delis are productive, and they feel fully capable of raising their own children.  That’s pretty remarkable.

What Haitians Want From Americans (and What They Don't)

What Haitians Want From Americans (and What They Don't) 
Sunday 04 April 2010
by: Beverly Bell, t r u t h o u t | Report 

We asked Haitians in civil society organizations, on the streets, in buses, "What do you want from the US? What help can Americans give Haiti?" Here are some of their answers:

Roseanne Auguste, community health worker with the Association for the Promotion of Integrated Family Health:

The US people don't know us enough. The first thing that Haitians need from the American people is for them to know our history better. They just see us as boat people. Especially Black Americans, we need them to know the other parts of our history, like that we defeated Napoleon. This would let them know that we're the same people.

By contrast, Haitians know what they like in the US. They don't agree with American policies, but they have no problem with the American people. Rap music, Haitians appreciate it a lot: Tupac, Akon, Wyclef - even though he's originally from Haiti. The Haitian people feel strongly about Michael Jordan, a Black man who beat up on the other players. On the back of taptaps [painted buses] you see Michael Jackson, the Obamas. It doesn't matter that Obama is a machine of the establishment; the fact that he's a Black American, they identify with him.

There have to be more exchanges between grassroots organizations in the US and Haiti. If the American people knew more about Haitians, if they had a chance to meet more often people-to-people, they'd see we have lots to share. We could build another world together.

Marie Berthine Bonheur, community organizer:

Do the US soldiers come to bulldoze? No way. We have a people who are traumatized. Is that a situation that you respond to with arms and batons? We're not at war with anyone. They would do better to come help us get rid of this crumbled cement everywhere. We need equipment to help us demolish these building. Help us have schools and hospitals. We need engineers who can help us rebuild, and psychologists and doctors.

We don't need soldiers. They just increase our suffering, our pain, our worries. 

Adelaire Bernave Prioché, geologist and teacher:

This country has a problem with skilled people, like all Third World countries. Once people get trained, they go to other countries.

This country needs youth to be trained in all domains. First, the Americans could help with this, for example with geologists. We lost so many teachers, we need people to teach. Second, we need massive investment to create employment to let people stay in Haiti.

Christophe Denis, law student:

The way the US is distributing aid ... a line of people waiting for rice and then across the street, a line of street merchants who can't sell their food. Are they sacrificing a class of people in the framework of aid?

Instead of supporting international trade to come in and crush us, reinforce our capacity for production and reinforce our self-sufficiency. The international commerce is just helping a small percentage. All that's produced in Haiti, it has to be strengthened.

Jesila Casseus, street vendor:

We want partnerships, people putting their hands with ours in the cassava pot to reconstruct our country. We don't want orders. We won't accept another slavery. We don't want dominion over us, we don't want to be turned into a protectorate.

Partnerships, okay. But NGOs are coming and sucking the country. They're taking our money and sending it back to where they came from. They're taking our riches and making us poorer.

Judith Simeon, organizer with peasant organizations and grassroots women's groups:

The American policy towards Haiti: none of the Haitian people want it. It's no good. The peasant economy was destroyed with the killing of Creole pigs [in the early 1980s, when USAID and other international agencies killed the entire pig population, allegedly in response to an outbreak of African Swine Fever]. That was the biggest crime of the American government. After that, the free market, neoliberalism - without thinking about the consequences - has crushed peasant agriculture and the rest of the economy even more. As for the rice that's coming in as international aid, what happens to the people in [the rice-growing area of] the Artibonite? Their production is destroyed.

If you're helping someone, you have to respect that person first. I can't tell you how it felt to watch the American soldiers distributing aid by throwing rice and water on the ground and having people run after it, like we saw on TV. That's not how you respect someone.

I can't suggest what else the US people should do. If you don't respect the dignity of a people, you can't help them. All this racist sentiment and action, we don't need that.

Chavannes Jean-Baptiste, director of the Peasant Movement of Papay:

When we speak of American imperialists, we make a distinction between government and people. We believe that a lot of people are conscious of what has happened to Haiti and don't want the imperialist project of the American government. There are a lot of things that we can do together. There are people here thinking seriously about alternative development in Haiti. There are many ways that progressive American people can help with that.

We need people in the US to tell the American government that what they are giving is not what we need. Why do we need 20,000 US soldiers? We don't. In Clinton's plan, there are free trade zones. We don't want that. We don't need them sending in American firms to reconstruct Port-au-Prince, either, which will just lead to its returning as the center of everything in the country. Rural areas could start producing construction materials that we need to rebuild. We need fruit plantations, we need irrigation systems, we need local agriculture industry.

American progressives could lead delegations to come see the country, so that when they return, they could help us reject the imperialist plan. Go out to the countryside, see that people have hope that they can change their lives. In the chain of solidarity, instead of sending food, send organic seeds, send tools, help with the management of water. A group in the US can work with a group in Haiti and help it build a cistern, dig a well, reforest, build silos to create seed banks of local seeds. Support groups that are reconstructing rural Haiti, that are creating work in the mountains. Help us establish rural universities. Help people who have left [earthquake-hit areas and gone to the country] be able to sustain themselves.

We need American people to say, "we stand with the popular project for the rebuilding of Haiti." We need it to be permanent, for Americans to continue to accompany the Haitian people, because the reconstruction of a Haiti is something that will take years.

This is the time to thank many groups for showing how much they are with the Haitian people, for doing all they can, for collecting medical supplies. There's been an extraordinary demonstration of solidarity.

Rony Joseph, policeman:

We need help reconstructing: roads, infrastructure, schools. We need a country that is modern. If you look at the world, you see globalization happening. Everyone has things that Haiti doesn't have.

You know, foreign countries are helping us a lot today, but I think they have an interest in it, too. When we have a problem in Haiti, the US and Canada get very concerned and start helping. Otherwise we might end up on their doorstep.

My Day In Photos

four adults on a moto... probably not the safest idea

I'm not completely sure what this rash was, it looked like tinea, but had an ulceration in the middle.

I didn't really know how to treat it, but the doctor cleaned it pretty well, then put some powdered azithromycin on it (meant for oral suspension).  Frankly, I'm not sure what I would have done, but that's probably not it.  Unfortunately, she has no real follow up, as it's a mobile clinic.

This little one is the first full-blown case of kwashiokor that I've seen in a medical setting.  They have a fairly decent referral system for true malnutrition.  He was referred to a local hospital, where he'll be getting medical-grade peanut butter ("Medika Mamba") for treatment.

Check out his growth chart from the health post... 

red is normal, orange is high risk, yellow is severely malnourished.

Another kid with Kwashiokor

If you can see the winding road through the mountains, 

you can almost imagine the city at the end, in front of the water... 

this is my daily commute to Delis!

Good discussions & Good wine.

            Yesterday, on the way to Delis, we had a great discussion about sustainability.  For some reason when you ask priests, teachers, and other “leaders” what they need for their communities, they say, schools, education, clinics, etc (maybe because they’re educated people themselves?).  But when you ask people, just regular average people, they want training.  They want their capacity increased.  They want to be able to work, to produce, and to earn an honest living.  There’s all sorts of partnership-building in Haiti, and many, many NGO’s think they’re listening to the community by supporting schools, churches, clinics, etc.  To some extent they are, but maybe they’d be better off investing in community development, training programs, cooperatives, etc… As my good friend, Dr. Igor, says, “two doctors, three opinions.”  Too many people (far more than two) consider themselves to be Haiti experts, but after all these years, doing things the way we’ve been doing them hasn’t stopped Haiti from being poor.  Maybe we need to find better ways to really listen to the communities.

            Wednesday, for my second day in Delis, I worked with the nurses.  Ultimately, I think AME-SADA will want a formal report from me with my observations, and to do that, I need to know how the mobile clinic really works.

            When the patients arrive, the local health agent checks them in.  The doctors then call the patients, see them, write their prescriptions and send them to the nurses.  The nurses fill the prescriptions, instruct the patients on how to take the medicine, and finally add in a few random pieces of advice (for example, you have 5 babies, you should really consider going to the health post for family planning, do you really need more children?)  Finally another health agent hands them a sandwich (some sort of generic Spam-mush on two slices of non-enriched white bread) and a small cup of lemonade.

Patients in line for the nurses

            Last night, I was invited to a party over Carla’s house in Gwo Jan.  They’re a couple that has lived in Haiti since the 1980’s and now runs a guesthouse somewhere near Petionville.  They had live music and dancing.  (We brought the wine.)  It was fun to relax, dance, and chat with people, both American and Haitian, who have made a real commitment to Haiti.

The house band