Setback #1 & #2... and their conquerings

   As most of you may have noticed, my interest is in sustainable grassroots health improvement.  Seeing a bizillion patients a day is a nice idea, but won't help anyone after I leave.  So I decided to partner with FIDA, a grassroots, community developing organization... but apparently noone told them that.  They do have health promoters in the communities where their cooperatives are.  Betsy and I agreed that PCH could set me up to go work with them, but PCH (FIDA's Haitian arm) apparently didn't understand that idea.  They noted that they didn't have a health-arm to PCH, so they sold me out to another NGO.
  I showed up to my meeting this morning and got a schedule of all of the mobile clinics that I was going to staff.  At each clinic there will be one or two Haitian doctors, plus a slew of nurses and health agents.    I asked about the health promoters and they dodn't know anything about them (except that they exist).  They then brought me to a meeting at AME-SADA (African Methodist Episcopal- Service and Development Agency.
   SADA is NOT a community-based organization.  They're a big NGO with a fancy office who sends out mobile clinics.  They were thrilled that I was coming along, because that meant that they could see more patients... Their mobile group goes out regularly, whether or not they have guest-doctorers.  But the flaw in their plan is my lack of papers.
   Betsy emailed me a few weeks ago stating that the Haitian government has new laws.  In order to practice medicine in Haiti, they need a letter stating that I'm a doctor in good standing, stamped by the Haitian embassy.  Well, I didn't exactly have a weekday to go hang out at the embassy on such short notice, and I didn't plan on practicing medicine either.  We agreed that for what we had planned, teaching, I would be exempt.
   The big wigs at SADA had a cow.  They went back and forth for an hour and a half about how I needed papers and I can't see patients without papers and I can't work with them if I don't have papers and on they went.  They had me convinced that I would have to re-plan my whole trip.  But I found a break in the discussion and explained our misunderstanding, that I was expecting to work with health promoters and to teach.  Unfortunately, their organization doesn't acknowledge health promoters, but even if I were to work in a teaching capacity, I would still need papers from the embassy.  The conversation went on and on, and they concluded that they would have to ask Betsy to take me to the American Embassy when she gets here so that I could get some form of official papers. My translator suggested that Betsy might be busy, and I agreed, stating that I didn't want to twiddle my fingers until she had a spare moment.
   They then decided that I could go and essentially shadow the doctors and "correct" them.  I nearly fell over.  With all of my vast experience, I shouldn't be correcting anyone!  Stealing Cliff's analogy, I explained that if a foreign doctor came into my office/hospital and started telling us what to do, we might be a bit offended.  They agreed.  We concluded that I would go with the doctors, see what they do, learn about the community, make some suggestions (their idea), and learn something from them (my idea).  I'll meet with the medical team on Friday, and I'm really hoping to get an amicable introduction... if they introduce me as the fancy American doctor coming to right their doctor's ways, I might just cry.
   With their conclusion, my wheels started churning.  Out of earshot, I explained to my PCH translator that the reason I signed on with their organization is because they are community-based and they empower people.  We agreed that SADA doesn't empower anyone (but their doctors).  I've agreed to go visit these communities and observe the current systems, but in my head, I have bigger plans.
 
   The WHO has many variations of a health system model:

Health promoter --> doctor/ clinic --> local hospital --> bigger centralized hospital.

I still think this model could work with the FIDA-PCH-SADA health model.  I'm a few steps further from that then I had hoped to be, but I have hope.  If SADA has mobile clinics that visit these remote areas from time-to-time (once a month?  I've yet to find out) and there are health promoters in the community, then maybe I could still work with them.  This trip, I'd like to go out on these mobile clinic trips, get to know the community, hopefully meet some community leaders, and seek out a potential host family.  If I can do some networking, perhaps I can make some more specific suggestions to PCH about what I can do and who I might work with in August when I come back.  I'd love to meet their community organizers and have meetings with the promoters to see what they know.  I'm sure the Haitian government will never let them write prescriptions, but I'm certain they could use some hands-on skills, like learning to splint and suture, at least to hold people over until the mobile clinic comes along.
   I've also been talking with another group that's staying here at Walls.  Their organization (CONASPEH) is affiliated with a Haitian organization that ran a school for nurses.  Unfortunately the nursing school collapsed during the earthquake, killing 21 nursing students, and is a long ways from being up-and-running.  On my last trip, I met a pastor whose wife was an American-trained family doc, and worked at that school, training nurses to use Where There Is No Doctor and preparing them to function in communities without doctors.  I like their model, but I'm personally drawn to more rural areas (for purely selfish reasons, I like them).  The CONASPEH volunteers and I agreed that it might be worthwhile for me to someday partner with their organization, particularly once the school is up and running.  I could guest-lecture there, and perhaps even borrow some of their instructors to come out to more rural communities.
  Big dreams, man.  I have big dreams.  But I'm getting there.  They'll evolve.  Plans will change.  Dreams will morph.  And good will happen.

The new "main area" at the guest house... I slept on a mattress in a nice little two person tent, all by my lonesome.  Best night's sleep I've ever had in Haiti!  It was cool and breezy, with NO mosquitos.