Guest Post

The following is a guest post from a freelance writer who is looking to add to her writing portfolio. She prepared an article entitled "Third World Public Health Issues" for my site and included her by-line (with a link to her site) underneath it. She tried to come up with something that seemed like it would fit my audience as well as was something she knew enough about to write fairly confidently on. She welcomes your comments.


Third World Public Health Issues

Not many of us are aware of the health issues that face the poor, especially those who live in developing nations. We take basic facilities like running water, clean toilets, hygienic and regular meals, and a warm roof over our heads for granted while children are being born every second into conditions of squalor and poverty. Lack of sanitation and no access to even the most basic of amenities ensures that people are beset by diarrhea, malaria, HIV/AIDS, malnutrition, and other chronic health conditions. While it’s true that organizations, both public and private, from developed countries are doing their best to alleviate this state of affairs, there are various fundamental issues unique to third world countries that prevent any kind of aid from working effectively:

Lack of infrastructure: Aid can only do so much – it can help treat existing conditions and use vaccines to prevent the reoccurrence and spread of diseases. What it can’t do though is build enough toilets, arrange for clean drinking water, provide the children with access to education, or ensure that the poor get to eat healthy food. While there are a few aid programs dedicated to improving the basic infrastructure in villages, there’s not much improvement that they can bring about, because of bureaucracy issues.

Political red tape, corruption: Politicians are known to be a greedy lot; they’re only interested in lining their coffers and looting public money as long as they’re in office, little caring for the needs of the people in their constituencies. Most third world nations are governed by power and money hungry politicians who create as much red tape as they can when it’s a question of foreign aid. They end up taking a large part of the money as bribes in return for allowing the aid crew to do its job. With continuous situations like this, disillusionment creeps in and does nothing to improve the status of the poor.

Malnutrition: Children are born to undernourished mothers, so there’s no chance for them to grow up healthy. Most street children live off food waste scrounged from dumpsters or beg for a living. With no regular source of food, malnutrition is a major problem. For aid to tackle this issue, the root must be identified, which means people must be given access to jobs that allow them to earn a decent living so that they can continue to feed their families. This again depends on various local factors, not the least of which is the government.

No education: With no education to speak of, men and women are hardly aware of the dangers of eating off the streets, living in filthy conditions, having unprotected sex, and drinking unclean water. And even if they are, there’s not much they can do about it, not without money. The little money that comes their way is squandered by the men on alcohol and tobacco, with the women being abused if they oppose this habit.

For aid programs to be effective and achieve their goal, long term planning, combined with local effort, is a must.

This article is contributed by Sarah Scrafford, who regularly writes on the topic of Radiology Technician Classes. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

Public Health Team Gives First Lesson for 300!

Webert, distributing toothbrushes.

Webert and Fritzner work in the girl’s home, taking names and doing general health exams.

In the children’s village, the team took down the names and ages of all the children living in each house, while at the same time, doing a general health exam of each child, noting who had scabies, ringworm etc.

The public health team giving their first public lesson to a group of nearly 300 children and adults after Sunday Mass. The topic was oral hygiene. Using posters, skits and even a monologue, the team emphasized the importance of taking care of your teeth and brushing twice a day. Everyone in attendance received a toothbrush and toothpaste.

By the end of the day, over 600 children and 20 adults received new toothbrushes and toothpaste.

Today is World AIDS Day. Today is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. AIDS has killed more than 25 million people with an estimated 33.2 million people living with HIV making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 3.1 million (between 2.8 and 3.6 million) lives in 2005, of which more than half a million (570,000) were children.

The concept of a World AIDS Day originated at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention. Since then, it has been taken up by governments, international organizations and charities around the world. (Wiki.com)

The following is a link if you’re interested in learning more about World AIDS Day and how to get involved in fighting HIV/AIDS around the globe. http://www.worldvision.org/content.nsf/getinvolved/hope-home

HIV/AIDS in Haiti

8,706,497: population of Haiti (2007 est.)110,000: Estimated number of people living with HIV/AIDS by the end of 2007

2.2%: Estimated percentage of adults (ages 15-49) living with HIV/AIDS by the end of 2007

53%: Estimated percentage of HIV cases that occured among women (ages 15-49) by the end of 2007

6,800: Estimated number of children (ages 0-15) living with HIV/AIDS by the end of 2007

7,500: Estimated number of deaths due to AIDS during 2007

Source
UNAIDS 2008 Report on the Global AIDS Epidemic. July 2008

Here are a few great sites if you’re interested in learning more about the demographics and epidemiology of diseases endemic to Haiti.

Globalhealthreporting.org
Kaisernetwork.org
Globalhealthfacts.org

It's not too late!

TO PLEDGE, simply email me at willinhaiti@gmail.com with your pledge amount per mile or a flat rate pledge.


TO MAKE A DONATION (CHECKS), please make checks payable to:

Theo’s Work, INC.2303
West Market Street
Greensboro, NC 27403
Memo: Will’s Medical Mission


TO MAKE A DONATION (CREDIT CARDS)

You can also donate using a credit card by visiting Pwoje Espwa’s website at freethekids.org

You can follow up your donation with an email to inquiries@freethekids.org to designate your donation to "Will's Medical Mission."


TO MAKE AN IN-KIND DONATION

If you would rather donate a service, product or frequent flyer miles, you can email me at willinhaiti@gmail.com


Thanks so much everyone! Nearly $16,000 raised in cash pledges and donations. $4,100 raised in in-kind donations!

Public Health Team Graduates

When I started the Public Health Education Program back in July, I began by teaching five bright and highly motivated boys, ages 16-20, who were residents of Castel Pierre Village, information about a variety of issues pertaining to public health including hygiene, sanitation, nutrition and water quality along with testing, treatment and prevention strategies aimed at reducing the incidence of several diseases endemic to the area. Last night, the boys graduated from the program and received a certificate, stipend and lab coat. Thanks to the generosity of several people in the states, the Public Health Team (PHT) will also be receiving "Sante Piblik" (Public Health in Creole) t-shirts, backpacks, hats and scrubs.

The purpose of the program is to spread as much knowledge relating to public health as possible, in hope that through education we can empower those most vulnerable in rural Haiti--the children. In order for this program to be a success it is crucial that the teaching is done through peer education, teaching Haitians to teach other Haitians. For this reason, I wanted to find a reliable and motivated student who can serve as my apprentice, who can then go on to teach a small group of interested “public health workers,” who will then go on to teach their peers in schools throughout nearby villages.

As public health workers, they are helping to teach health education classes, running mass treatment programs for scabies, ringworm and tuberculosis, and doing daily surveys of the living quarters looking for health hazards and accompanying children who are sick to the clinic and making sure that the children on TB and Malaria meds are adhering to their regimens. Paul Farmer had it right when he said that the only way to make it sustainable was to teach Haitians to treat Haitians. It won't happen overnight.

The program I have designed was made specifically according to the needs and interests of the residents at Pwoje Espwa and nearby villages. The lesson plans are translated into both English and Creole. Accompanying each topic covered, is an oral/written exam and or an oral/written project assignment for the students to complete. These means of evaluation are in place to ensure that the public health students retain a firm grasp on the material so that they may teach their peers in both informal and formal settings. The program is designed to be completed in three months time, which includes a 2-week period of mock-teaching, where the public health students will take turns presenting all of the material we have covered over the span of the program.

The following is a list of the topics covered in order as to which they were originally taught:
· Malaria—testing, treatment and prevention
· Scabies—treatment and prevention
· Prevention vs. Treatment
· Home Remedies and Popular Beliefs
· Witchcraft, Magic and the Evil Eye
· Common Causes of Sicknesses
· How to do a Physical Exam
· How to Care for a Sick Person
· Alternative Medicine
· The Healing Powers of Water
· The Use of Antibiotics
· How to Give Medicine—Measuring Doses
· First Aid
· Nutrition
· Prevention via Cleanliness
· Prevention via Sanitation
· Parasites—testing, treatment and prevention
· Prevention via Vaccinations
· Prevention via Other Habits and Behaviors
· Dehydration, Diarrhea, Dysentery and Vomiting—treatment and prevention
· Tetanus and Rabies—treatment and prevention
· Ringworm
· Teeth, Gums and Mouth Health
· Sexually Transmitted Diseases—testing, treatment and prevention
· HIV/AIDS—testing, treatment and prevention
· Children’s Health
· How to Teach



Ambroise (Sam) Mackenzy
Webert Constant

Delince Pierre

Marckenson Gedna

I'm so proud of these boys and am excited about what comes next! Their first public health presentation for the 650 children of Espwa will be this Sunday. The topic is on oral hygiene, with a focus on how to properly brush our teeth. After the program, they will be handing out toothbrushes and toothpaste (donated by the Athens Medical Group) to all of the house monitors for the children.

On Sunday evening, they will also be going house-to-house with Elimite cream and mass treating all of the children for scabies.

The purpose of my running the Cayman marathon next Sunday is to raise money for programs such as these. I know this was a long post but thanks for hanging in there!

TB Treatment Programs

This post is for the man working in Gonaives, Haiti who contacted me regarding where he can send patients with active TB. The organizations I have found to be the most helpful and the most equipped in handling active TB patients in your area are PIH in Cange, GHESKIO in PAP, Missionaries of Charity in PAP and Hospital Albert Schweitzer in Deschapelles. If you're interested in any of these places, let me know and I will give you any contacts I have. Email is the best way to reach me willinhaiti@gmail.com Best of luck!

Surgery

In the pharmacy, reading up on what to do with a Filariasis patient.

Going over the list of available meds on the first day of clinic.

Learning how to work the ultrasound machine.

Fritz and I in the lab. I'm running a hematocrit while he checks for sickle cell in a blood sample.

Assisting Dr. Saydjari on a minor hernia.

For the last two weeks, we were visited by a group of four doctors (2 family practitioners, an ER doc and a general surgeon), a nurse practitioner, nearly a dozen nurses and technicians and a handful of civilian volunteers. With their help, we saw 800+ patients, held 3 mobile clinics in areas even more rural and seemingly unreachable than where I’m stationed and performed two dozen surgeries. They came down with thousands of pounds of medicine and other medical supplies, thousands of toothbrushes and toothpaste along with action packers full of school supplies, sneakers and sandals for those patients who come to clinic barefoot.

We worked out of abandoned houses and used giant metal shipping containers as our clinic dividing the space into a pharmacy, laboratory, two exam rooms and an ultrasound room. We used the space in between the two containers as a consultation area and had triage positioned under a pavilion made of palm tree branches. There were 100 + people waiting outside every morning, hoping to get a bracelet that would allow them to be seen by one of the doctors. Examining up to six patients at a time, we saw everything from impetigo to walking pneumonia to elephantitis and hydroceles.

The amount of information I learned and experience I obtained these past two weeks was incredible. Allowed to assist on several major hernias, hydroceles, lypomas and other minor surgeries, I quickly realized how there was nothing fake or unrealistic about the work I am doing. The ability to remove a tumor from a woman’s breast or give a man back his ability to walk by replacing a massive hernia is nothing short of amazing, considering the lack of a sterilized operating room, 90 degree heat, and little to no electricity. The doctors and nurses who visited are some of the best in their fields. The speed, accuracy and grace in which they operated, treated and cured the patients they saw was nothing short of inspiring. These past few weeks reminded why I want to be a doctor.

Update on Lixier

Our baby boy with hydrocephalus has been back in Haiti for nearly a month now and doing well, until last week, when his mom paid us a visit. She was worried that Lixier's shunt was infected again. The shunt was infected once already while he was still in the states but they were able to replace it before he returned to Haiti. An infected shunt in Haiti is a death sentence. The only pediatric surgeons to come to Haiti are visiting ones, who spend little more than a few weeks of the year in the capital city. The only option would be applying for another emergency medical visa and trying to get Lixier back to the states for a replacement. With the help of Dr. Brodie and Dr. Stern from the states, we were able to get a few replacement shunts sent down to us. However, we would still lack the most important part, someone to perform the procedure.

Luckily, a visiting doctors group was here when Lixier's mom came by. Within minutes, we had a neurosurgeon from the states on the phone instructing us on how to "tap" the shunt (withdrawing cerebral fluid to determine if there was indeed an infection). The fluid was to our relief, crystal clear, meaning that there was no apparent infection.

It's hard to believe that Lixier is already 8 months old. It's been nearly 5 months since I helped get him a visa to the states and he looks great. I realized that day, as we were performing the "tap" how much it would affect me if we were to lose him after so much effort was put into saving him. It wouldn't be easy.

I promise I'll respond

Since the start of my blog, five months ago, I have raised tens of thousands of dollars, made unbelievable contacts and networked with other non-profit and non-governmental organizations from around the world. On average, I receive 100-150 emails from you all regarding each of my posts. As I have very limited access to internet and not much spare time in a single day, it will some times take me upwards of a week to respond to your questions, comments and concerns. Please be patient with me and understand that your emails are very important to me. I will do my best to post regularly in these upcoming two weeks but will be working 16-hour days among the clinic, public health classes (my students will be graduating this month) and marathon training leaving me little to no time for accessing my computer.

Thanks for your understanding and please keep those emails coming. I love to read what you have to say!

$12,000 Raised So Far!!!

Thanks to the help of many, I've received $12,000 in pledges thus far for the marathon that I'm running in an effort to fund much of the work I've been involved in these last 5 months! If you can pledge any amount at all, please do so! We're a long way from the $60,000 goal!

If you pledged:
$1/mile x 26.2 miles ($26.20), it would take 1,832 pledges to reach my goal.
$2/mile x 26.2 miles ($52.40), it would take 916 pledges to reach my goal.
$5/mile x 26.2 miles ($131.00), it would take just 366 pledges to reach my goal.
$10/mile x 26.2 miles (262.00), it would take only 183 pledges to reach my goal.

TO PLEDGE, simply email me at willinhaiti@gmail.com

TO MAKE A DONATION, please make checks payable to:
Theo’s Work, INC.
2303 West Market Street
Greensboro, NC 27403
Memo: Will’s Medical Mission

You can also donate using a credit card by visiting Pwoje Espwa’s website at freethekids.org

You can follow up your donation with an email to inquiries@freethekids.org to designate your donation to "Will's Medical Mission."

Thanks! -WILL

Back from the Dominican Republic

On Friday, I caught a flight to Port-au-Prince and then took a bus to Santo Domingo where I stayed for five days. After five months, I'd be lying to myself if I said that living here is a piece of cake. Everyday is a struggle. I'm currently leading 12 programs that are covering everything from disease treatment and prevention to hygiene and sanitation to public health education. I'm well aware of the load I take on and I do so happily but there are definitely moments when it feels as though my back is about to give out from all the weight. I've never been known for taking the path of least resistance and for that reason, I seem to welcome obstacles as nothing more than checkpoints that keep me on track in reaching my goals.

Having never been to Santo Domingo, I decided to take a short break from the stress that was becoming unbearable. I love the work I do and I see the impact I have all around me but still I find myself in search of constant motivation and inspiration. Since being here, I have been challenged emotionally, mentally, physically and spiritually on a daily basis. My will to succeed and my drive to accomplish the goals I have set have never been stronger. However, it's become easier and easier for those things to become clouded by doubt and hidden by frustration and a lack in faith.

While I was gone, the public health classes continued uninterrupted and Fritzner even distributed the written test on nutrition and parasites that I had worried wouldn't get done. After the first week of the new TB DOT program, it seems to be a success! I'd like to get my public health team some cool t-shirts and backpacks that say ("Pwoje Espwa Sante Piblik") (Project Hope Public Health).

The fundraising for the marathon is coming along. I'm up to about $11,000 in pledges so far and am hoping that in the next month I'll reach my goal of $60,000.

Before I ever wanted to be a doctor, I wanted to be an architect. All those CAD classes in high school finally paid off when I was asked to design a new public health center for Pwoje Espwa that would serve all of the neighboring villages. I've finished the new clinic design and while I'm still searching for more funding, we will soon be showing the design to an engineer who'll help us get up and running.

TB Treatment Begins

I've just finished doing the TB skin tests for all of our new children and those that somehow slipped through the cracks in previous years. Starting Monday, my public health team will begin distributing INH prophylactic drugs to the 145 children and adults that tested positive on their PPD tests. (The PPD is a special skin test for tuberculosis. There are many different names for the PPD, including TB skin test, tuberculin test and Mantoux test. PPD stands for purified protein derivative). Often times, a person who lives in an area where TB is endemic, will test positive by exposure. Therefore, a positive test does not necessarily mean that you have tuberculosis, however, it does mean that you have an increased risk of developing TB later in life. For this reason, anyone who tests positive (11mm or greater) is being put on a nine month regimen of INH treatment. This treatment is a prophylactic that when taken regularly, can reduce the chances of developing TB by up to 90%.

TB is among the leading killers of contagious diseases worldwide. It is caused by a bacterial infection and mainly affects the lungs, but can also affect other organs. TB is very common, especially in poorer socioeconomic settings and the developing world. It can be found in prisons and homeless shelters and overcrowded homes. You may even know someone who has it. TB is contagious, so if you live with someone who has TB, it is important to be tested as soon as possible.

Under normal circumstances, a positive TB skin test should be followed by a chest x-ray. However, resource poor settings such as ours do not allow for that luxury. Instead, everyone who tests positive receives a physical exam where we listen to their breathing and ask them a series of questions in order to discover the presence of any active TB symptoms (cough, including bloody phlegm, weight loss, fever, night sweats, difficulty breathing etc.)

TB can be treated with medications, but you must take them every day. The best way to ensure adherence is to institute a directly observed therapy program (DOT) which is what my public health guys and I are doing. The INH treatment we are dispersing requires that a person take one pill, twice a week. Each of the public health team members have a list of 30 names of people who they need to give medicine to every Monday and Thursday morning. I supply them with a jug of water, cups, 30 tablets and a checklist to keep track of who has received their meds. After an intense three-day seminar on tuberculosis, my team understands how important treatment is for TB and for that reason, they are dedicated to searching for everyone on their list twice a week and watching them take their medicine.

Last year, the success rate of INH completion was under 48%. This year, we have nearly double the number of kids on INH than last year. With a DOT program in place, I'm hoping to see at least 90% completion. We start everyone on treatment Monday and will finish just before school lets out for the summer. Wish me luck!

Food and Nutrition Program

One of the projects that I’m fundraising for by running this marathon includes the addition of more nutritious foods to the children’s diets. I’ve recently begun collaborating with an organization called Global Nutrition Alliance. The organization strives to bring focus to the nutritional value of food rather than its number of calories. I am working on putting together a most accurate picture of the current nutrition situation of our kids so that GNA’s nutritionists can begin to put a plan together that can fill the inadequacies uncovered. Once this is complete, we will be working together on an action plan that will help us to get the food and/or supplements transported and distributed.

Family Portrait

Choupy, one of our most talented artists at the orphanage painted this family portrait for me from a photo I gave him from graduation. Though it looks nothing like us, the 4' x 4' painting is beautiful in person.

Things are moving forward

The Tuberculosis testing and treatment program is off the ground. Within the next week or two, I hope to have all of the children who test positive receiving INH treatment. Dr. Cynthia, a nephrologist from Maine and the Medical Director of the clinic along with Dr. Jerry, a pediatrician from Alaska helped me to plan out and execute the first part of the TB program during their 8-day visit from the states. I’ve been spending a few hours each morning giving out PPDs to test for TB, reading results and listening to the chests of every child/adult that tests positive. If the patient is breathing clearly and has no complaint of coughing, I move them on to INH prophylactic treatment to help prevent them from developing active TB later on down the road. If their exam doesn’t come back clear, then that’s my cue to send off for a chest x-ray and move carefully from there.

The medical group that came along with Dr. Cynthia and Dr. Jerry included two other nurses, Hervè and Claudette who helped to distribute tetanus shots and oraquick tests (oral HIV/AIDS testing) and Dr. Drew, a dermatologist from Virginia. Everyone from this group except for Dr. Jerry was a part of the first medical team that I participated in on my first visit to Haiti in January. It was great to see everyone again. Dr Drew let me assist on a big cyst removal and gave me several pointers on how to better my suturing and helped teach me to identify and treat several of the skin problems that come into the clinic on a daily basis.

While Dr. Cynthia was here, I went over the new design for the public health clinic that I put together with her. She liked my ideas and gave me the ok to push forward and get going on fundraising and development. The kitchen hygiene and sanitation project that I initiated a few weeks back is now at phase II until I can secure the remaining funds to begin constructing the new building.

Running Update

My new running partner is Fritzner Phanor. He's 22 years-old and has been living at the orphanage since he was 13. He was one of the first boys I befriended when I moved down to Haiti and we've been inseparable ever since. Throughout these last four months, I've worked with Fritz every morning Mon-Fri, doing public health training and teaching him about various testing, treatment and preventative methods regarding several diseases endemic to the area. Now that he is comfortable with the material, we've started a public health team of five older boys from the orphanage who we are teaching to become public health workers that will go out into the villages and do outreach. I do the lesson plans and Fritz teaches the class. He's great with the guys and gets them excited about the material. He's committed and passionate about his work and the difference he's making. Sponsored by a hospital in Maine, he's been granted the opportunity to attend a lab tech school where he can get the medical training he's been longing for. All of the children at the orphanage see him as a role model, a great soccer player and an overall good guy. It was obvious that he was the perfect person to run this marathon with me.

Training is going great! Last Sunday, we did our first 18-mile run. We started at 5am to avoid the midmorning sun and were amazed at how much faster and comfortable we were. However, by 6am, we were already running in 80 degrees. The course I took us on included 2 miles of rocky road, 1 mile of dirt path, 12 miles of paved road and 3 miles up a mountain road. We finished in just under three hours. I assured Fritz that there are no mountains at the marathon, nor will we be running in the same 90-95 degree weather that we're used to running in here. "We're working extra hard so that the real run won't be nearly as intimidating as it seems," I would tell him. We're running about 45 miles/week with Mon & Fridays off for cross training.

I've got running trails mapped out all over the area so that depending on the day and mileage, we take a different course. Some are muddy and rocky while others are nearly all paved. I like to save the paved road for our long runs on Sundays, mainly because it is the same surface we'll be running on for the marathon but also because it is not easily accessible and requires us to run 2 miles down a rocky road with tons of potholes and difficult terrain before we can reach it. It's not worth the trouble if we're running just 6-8 miles on a regular day.

New Email Address

Hi Everyone!

My Brown email address has been canceled because I am deferring a year. Please use my new email willinhaiti@gmail.com

Thanks!

Searching for a dentist

Fr. Marc (founder of Pwoje Espwa orphanage) came to me with a problem. Several of the children in the village are suffering from horrible toothaches and we have no way of easing their pain besides giving them some ibuprofen. He asked me to go into town to find someone who can help. The next morning, I hopped on the dirt bike with my right-hand man, Fritzner (the boy who’ll be running the marathon with me) and headed into town to search out any and every dentist I could find. We visited six dentists in under two hours, not including the three dentists we met at the General Hospital where they only pull teeth and nothing else. They all gave me their prices and worked to convince me why I should choose them to be our “go to dentist” for our 640 children. Their prices ran the gamut, as did the services the dentists able to provide. At the end of the day, I found the perfect dentist. She even agreed to come to the orphanage for consultations, tooth pullings and training sessions on good mouth hygiene.

They were all very nice and took time out of their day to talk to me with no advanced notice. Two dentists, left their patients in the middle of a procedure to sit down and speak with me. It’s amazing how the color of my skin seems to command immediate attention in this country.

A Shooting Star

It’s 3am. I woke up from the sound of my fan going on and off which means that our batteries are wearing out and soon there will be no electricity at all. When this happens, it’s best to turn everything off and save what little battery we have left for when we really need it. I’ll post this message as soon as the internet is back up

Once awake, there’s no way I’m getting back to sleep. I turned off my fan, put on some sandals and left my room for the cool night breeze. I climbed the little ladder outside my door and ended up on my roof, looking up at the brightest stars I have ever seen. The skies are so clear down here. You can see every star. In fact, there are so many stars that stretch so far, that it’s difficult to look up at them while standing. The vastness of the night sky is dizzying. I sat down on the cement roof and looked out to the East where earlier tonight, you could‘ve seen the lightning from the thunderstorm just beyond the mountains. And that’s when I saw it. It was a shooting star, brilliant and unmistakable. I’d never seen a shooting star before and I’m sure that if I had, it couldn’t have been brighter than the one I saw tonight. I sat there mesmerized, anticipating a storm of falling stars. As I write this, I realize that I failed to do the single most important thing when you witness a star shoot across the sky—make a wish. I’m sure it’s not too late to make it up.

What is it?

I’m awake again. It’s about 1:30am. There is no electricity, so I’m just running on the remainder of my computer battery. By the time I post this message, it will be a day late.

I can’t remember a time in my life when I have fought so hard to sleep. I always considered myself one of the lucky ones—someone who could fall asleep under any circumstances, be it loud noise, extreme heat and even on an empty stomach. In school, this would often prove to be more of a curse than a blessing, seeing as how it took little more than the sound of my teacher’s voice to send me off to dreamland. But now, now I wish for that ease. I’ve tried putting a movie into my computer, listening to music, reading a dull book, but each attempt to tire myself fails. I wind up not watching the movie, not listening to the music and staring blankly at the page in front of me. I don’t know what it is. There is something on my mind, something unsettling or at the very least, distracting. I’ve tried to pinpoint it by writing in my journal but the task of free writing proves to be overwhelming.

I miss my family terribly. I think about my friends all of the time. I find myself retracing my entire life over and over, reliving the greatest and worst moments, until I find myself back here, in Haiti, surrounded by four walls of dirt, alone, laying on this hard mattress, looking up at the dark ceiling, to the loud hum of my fan.

Then I think about what it’s like when I wake up in the morning. The rising sun that fills my room with bright light, the cool morning breeze that has forced me under my sheets and of course, the sound of roosters crowing, cows mooing and children laughing. I look forward to the moment I first step outside of my room, for I will surely hear my name called by at least a half dozen smiling children.

It’s no secret, the emotional strain that comes with leaving those you love behind and moving to a place like Haiti. Faced daily with sickness, disease, hunger and suffering, I would have surely believed that after several months, my heart would have hardened into a rock, impenetrable by the injustices one becomes accustomed to seeing here. However, that was not the case. If anything, I find myself ever the more sensitive. I’ve been here 3 ½ months. I’ve learned the language, traveled the country, met with some of Haiti’s elite and treated some of its poorest. I don’t claim to have seen everything, but I’ve seen a lot and I’ve grown immeasurably over these last few months. I’ve been changed by this country.

It was a long day

I can't sleep. I woke up with the fan on me this morning which is always a great start to the day because it means we have electricity. At 5am, I was at my computer typing up the day's lesson plan for my public health group. The lesson topic this morning was "Prevention vs. Treatment." Every weekday morning, from 8-11am, I teach 5 of the older boys at the orphanage about various diseases, testing and treatment methods and preventative measures. Depending on the complexity of the topic, we may spend an entire week learning about a single disease. After each topic, I give them a written and oral exam to ensure their grasp of the material. It's important that they are comfortable with the material, because at the end of the three month training program, they will be the ones who'll be entering classrooms in the local primary and secondary schools to teach others what they've learned.

My goal is to spread as much knowledge relating to public health as possible, in hope that through education I can empower those most vulnerable in rural Haiti--the children. To understand what those itchy bumps are all over your body and how to get rid of them and avoid getting them again is priceless for a child covered in scabies. To learn about parasites and why it is smart to avoid drinking dirty water may help prevent a child from getting worms, diarrhea and dying from dehydration. If this all sounds a bit dramatic, I assure you that it's no exageration. I've seen things that have made my skin crawl and it bothers me horribly that I can't be there every time to stop these easily preventable sicknesses from happening in the first place.

On another note, marathon training is going well. I've recently recruited one of the older boys from the orphanage to do the marathon with me. His name is Michel and he's one of our best soccer players and loves to run. He's been training with me for about a week now and he absolutely loves it. He's in great shape and has his heart set on winning first place. I must say, his drive to succeed is inspiring. I believe he's got enough heart to do anything. Fr. Marc bought him a pair of running shoes and some shorts. I've started him on a runner's diet, chock full of carbs, electrolytes and vitamins. It's great to have someone to run with. In the next week or so, we'll be getting him his passport and booking his very first flight for his very first time leaving the country. We're both through the roof excited and are counting down the 87 days until the race!

Water,water everywhere, but not a drop to drink

For the last 12 hours, we've had non-stop torrential rains that have flooded the children's homes and parts of the village. At the same time, our water tanks have run dry and our wells polluted. The river has risen nearly 10 feet and homes are several feet under water. The people I talk to can't remember a time when it rained this hard for this long. Though rainy season can sometimes consist of weeks of heavy rain, it doesn't cause the flooding we're seeing here today. The ground was already saturated from the tropical storm and hurricane we were hit with a few days back.

There is water everywhere. Under these conditions, a normal response would be to run and hide, head for higher ground and stay dry. However, these people have no where to go. Their few material posessions are being swept down the rivers that were main roads just yesterday. Even our children, better off than the majority of the population, have no boots or rain gear to tread through the lake that has become our village. There is nothing to stop the rain from coming into their houses so the children give up their clothing to cover the windows.

The only thing I hate more than seeing these people continue to suffer , is the fact that I'm here to witness it and unable to do anything about it.

Running for Haiti (runningforhaiti.blogspot.com)

Hey Everyone!
Check out my new blog at runningforhaiti.blogspot.com!
As you know, I've been training for the last 2 months for the Cayman Islands Marathon on Dec. 7th. I will be running this marathon both as a dedication to the children I work with and as a fundraiser for the work that I'm doing in Haiti. Pwoje Espwa, the organization I am working with is saving lives daily. You can help contribute by sponsoring me to run by making a donation and/or pledging a dollar amount for each of the 26.2 miles that I’ll be running. Check out my new blog for details.

Stay Posted for Updates! Thanks again!
-Will

Time for a little update

There has been so much happening these last three weeks that I hardly have the energy to write about it all so I will do my best. First thing’s first. I’m back in the states and when I’m not meeting with deans, doctors or prospective volunteers about Haiti, I’m spending as much time as possible with my family. It was just recently my best friend’s, niece’s, mom’s and brother’s birthday. So, I’ve had a lot of celebrating to do. Since being back, I’ve had the opportunity to reflect on my last few months in Haiti and was forced to articulate my experiences to friends, family and others. This is what I dreaded about coming back here. The entire plane ride, I rehearsed what it is I would tell people. I practiced over and over and struggled to find the perfect words to describe what I’ve felt, witnessed and experienced. By the time I landed in Boston, I had a nice size spiel put together that I had planned to use for everyone I was going to encounter on this short 11 day visit. I sit here today, realizing that I’ve yet to say a single sentence from that spiel I’d spent so long practicing. I’ve had no problem talking about Haiti. When the opportunity arises, I can’t stop talking about the country and the people that I’ve fallen head over heels for.

There is so much to say about the “situation” in Haiti. Everyone has their own opinion as to what happened to the country that once had the fastest growing economy in the Caribbean and is now the poorest country in the Western Hemisphere. How is it that this story has gone untold for so long? Why is it that billions of dollars later, it remains the poorest country? As of 2006, Haiti had the largest concentration of NGOs (non- governmental organizations) and NPOs ( non-profit organizations) of any other country in the world and also held the record for receiving the most charitable aid of any other country in the world. We’re talking about billions of dollars a year, and nearly 10,000 NGOs and NPOs in Haiti. It goes without saying, but there’s something seriously wrong with this picture.

Still no internet

I just rode into town on the motorcycle to put up a quick post letting everyone know that we still don't have any internet and that I'm doing fine. I'll be leaving Les Cayes on Monday to begin a day-long journey to Deschapelles to visit the Albert Schweitzer Hospital. Providing all goes well, I should be back in Cayes by Wednesday afternoon.

A quick update on Lixier, the baby boy with hydroencephalitis: He was scheduled to fly back to Haiti with his mom today but the plans were canceled because he recently fell ill again. The doctors believe that he's experiencing complications with the shunt that they put in his head and are debating whether or not they need to remove it and replace it with another. I'll continue to spread the news as I get it!

There are no more bed bugs in the 20 children's homes! The malaria project starts on Monday with all of the treated window screens being made for all of the houses. I'm trying to apply for some grants but am limited with internet access. If you can help to sponsor a house for the project, it would be greatly appreciated. The following is the cost breakdown for a single house :

Insecticide spraying every 3 months for 1 year= $20
Insecticide treated screen windows =$150
Rock pathways and buffers around the house to eliminate standing water=$110
Labor costs=$70

For $350, you could help me to drastically reduce the incidence of malaria for the 25-40 children that live in each house.

You can send a donation to

THEO'S WORK, INC.

2303 WEST MARKET STREET

GREENSBORO, NC 27403
Memo: Will's Medical Mission

Donations are tax-deductible in the U.S.

Or

You can donate with a credit card at the website (theoswork.org) and designate the donation to "Will's Medical Mission," and just follow up your donation with an email to inquiries@freethekids.org to confirm that your donation was received!

Thank you so much for your help. I promise to post a more complete update as soon as I get a more stable internet connection!

Going home

While we have had electricity, the internet has been out for the last week after our satellite mysteriously fell out of the sky. I’m in town at a hotel using their wireless now just long enough to let everyone know that I haven’t fallen off the face of the planet. I’ll send out an update as soon as we get our internet connection back.

I’ll be flying into Boston on Aug. 14th for the birthday of my niece, mom and brother. I’ll be staying in Providence from the 15th to the 24th and will be flying back to Haiti on the 25th. This will be a great chance to stock up on needed meds and supplies for the clinic, do some fundraising and visit a few people that I’ve been missing very much. I can’t wait to see my family. I’m counting down the days.

Bringing ballroom to Haiti!

I decided to get a bunch of the kids together to teach some Salsa and Merengue lessons. Seeing as how we were a little short on girls, most of the guys were forced to practice with each other. They didn’t mind much though. For about two hours, the place came alive with Latin music that could be heard from down the road. It didn’t take long, however, until the music changed to hip hop and the kids began to show off some of their own moves! The group quickly grew to several dozen of all ages. It was a great time. It gave me goose bumps watching some of them dance. Once the music comes on, it’s as if they come alive, even the quietest boy.

Now, there are a ton of kids who want to learn more. I'm going to begin working with a few of them to choreograph a ballroom/latin piece that they can perform. Though this may seem a little strange teaching ballroom in rural Haiti, the reality is that Haitians played an important role in the creation of mambo/chacha along with Cuba and the Dominican Republic. Also, have you ever heard of Jean Michel Erole? He's Haitian and a world professional ballroom dancer!

Yesterday, a bunch of us ignored the T-storm warnings and embarked on an hour trip out to see my first waterfall. As you can see from the picture, it was beautiful. There's a 25 ft and a 50 ft jump off point on the rockwall into a deep pool of cold water. It was a great day with great weather. When I wasn't swimming, I spent most of my time just sitting on a rock trying to take note of everything around me. I've never seen such a sight. The river flowed for miles with thick forest on both sides and trees leaning so far in as to cover the river. It reminded me of something out of Jurassic Park.

Weber, spraying one of the children's houses with insecticide. He helps out around the clinic and wants to be a doctor. He'll be joining the public health team I'm putting together.

Bed bugs and Malari

We’re about 75% done with the bed bug project in the southern village of the orphanage (20 houses). I have a group of five dedicated boys who wake up early each morning to help me with the spraying and caulking of the houses. Most of them are in the English class that I teach, so we use the time working together to practice their English and my Creole. The work we’re doing is not easy but we keep it interesting by exchanging jokes and proverbs all day to help pass the time. I like to surprise them with ice cold Cokes and snacks on the long days. Once we finish with the bed bugs, I’d like to get started with the malaria prevention program, getting screens put up around the houses, bringing in the treated bed sheets and putting up the rock buffers around the children’s homes. The total cost of implementing the program will run about $350/house. We’ve got a total of 35 houses to fix up with two houses sponsored so far. Please let me know if you’d like to sponsor a home.

Malaria is spread by the bite of an infected mosquito. In areas of high malaria transmission, such as Haiti, the population develops partial immunity to the parasite. However, children remain most at risk for malaria because they have not yet developed immunity, which happens over time from repeated bites from infected mosquitoes. Many children in malaria-endemic countries such as Haiti are anemic, with a low level of red blood cells. An anemic child is more at risk for malaria and for developing severe anemia. Malaria destroys red blood cells, leaving an already anemic child with little, if any, resources to fight the disease.

Forty-one percent of the world's population live in areas where malaria is transmitted (e.g., parts of Africa, Asia, the Middle East, Central and South America, Hispaniola, and Oceania). Each year 350–500 million cases of malaria occur worldwide, and over one million people die, most of them young children. In 2002, malaria was the fourth cause of death in children in developing countries, after perinatal conditions (conditions occurring around the time of birth), lower respiratory infections (pneumonias), and diarrheal diseases. Malaria caused 10.7% of all children's deaths in developing countries.

Thank you!!!

Thank you to the Ridgewood YMCA for bringing 650 toothbrushes and tubes of toothpaste, 100 bottles of shampoo, 10 brand new soccer balls and thousands of pens and pencils for the schools!

Thank you to everyone who has donated to help me with the work that I’m doing! With your help, I’ve raised enough to buy a vaccine refrigerator for the clinic, ringworm and scabies medicine, and enough insecticide for all of the children’s houses to kill off the bed bugs and am receiving help from an expert database consultant who will be developing a user-friendly case registry for our Tuberculosis treatment program! We’re also having 420 bed sheets that are treated with an insect repellant good for up to 70 washes donated!

Updated Wishlist

*AAdvantage Miles-as many as possible

*Public Health Van- $15,000

*Public Health Dirt Bike/Moto- $3,500

*Daily vitamins for all of the 640 children- $50/week x 52 weeks= $2,600/year

*Treated window screens for the children’s houses- $100/house x 35 houses= $3,500

*Toothbrushes $1/each x 640 children= $640

*Water quality tests for bacteria $5/each

*Medicine of all kinds (email me for an updated list of our most needed meds)

*Laptop for the clinic (can be donated)


It is best to make a monetary donation for all medicines as it is very difficult to get medicine through Haitian Customs. Medicine being shipped to Haiti can be held for up to a year in Customs before it is approved for release. Often times the medicine is never released because it expires in holding. By donating monetarily, you are helping us to purchase the things we need in Haiti while also supporting Haiti’s economy.


There are also several projects that are being developed in need of funding. Please email me for more information.

• Malaria/Dengue Fever/Filariasis Prevention Program


• Malaria/Dengue Fever/Filariasis Diagnosis and Treatment Program


• Malaria/Dengue Fever/Filariasis Education Program


• Community Health Training Program for children and house monitors

Lixier after surgery. The battle is not over for Lixier but his surgery would not have been made possible without the help of many, including Pwoje Espwa and St. Joseph's Hospital. Thank you!

Mark, Dora and Bruce helping out at the clinic. Dora is a gastroenterologist and Bruce is a cardiologist. Mark's going to be studying premed at Loyola in the fall.

Good News x 3

1-Lixier’s surgery was a success. He and his mother will be spending the next 30 days in the states so that Lixier can get the proper follow-up treatment he needs. I saw Lixier’s father the other day in town. He couldn’t stop thanking me for everything we’re doing for his baby boy. I can only imagine how difficult it must be for him to remain in Haiti while his wife and child are away. He misses them very much.

2. The bed bug project is underway! The first 10 houses of the 20 houses in the children’s village have been sprayed with insecticide, caulked, sealed, locked and painted. They’re beginning to actually look like homes! I’m still trying to raise some funds for the malaria program to get window screens put in all of the houses.

3.Hannah Winkler, a librarian at University of North Carolina in Greensboro is down for 6 weeks helping to establish a library for the children. She’s been working every day, cataloguing hundreds of books, organizing, processing and shelving them according to language, binding old books painting bookshelves and lots more. She’s fun and excited about being here. 25 years old, passionate and motivated, she’s already experiencing the difficulties involved in trying to get anything done down here.

Mark Brodie, a recent graduate of Dartmouth College. He’s also down here for 6 weeks helping me out in the public health field. He’s been a huge help in developing the bed bug project plan and is a big sports guy. He loves to play soccer with the kids and attracts quite the crowd when he goes for his morning jogs around the soccer field. The kids don’t seem to understand why someone would run just to run.
Mark’s parents came down last Sunday and will be leaving tomorrow morning. They are both physicians and very nice people. Dora is a gastroenterologist and Bruce is a cardiologist. Having never been to Haiti before, they wasted no time getting settled in. Their second day here, they were getting dirty with the rest of us working to fix up the children’s houses in the village. They worked all day long every day and never once complained. They fly out tomorrow morning to head back to the states. I wish they could stay longer. They’ll be missed.

Baby Update!

The baby boy (Lixier) with hydroencephalitis was just approved for his Visa last night! He and his mother will be leaving for the states on Saturday and Lixier is scheduled for surgery on Monday at St. Joseph’s Hospital. It was a long and stressful process but it looks like things will work out after all. However, surgery is only half the battle. His follow-up care will be crucial in helping him to stay alive. As it is very difficult to receive the post-operative treatment he needs in Haiti, the host family in the US has offered to house Lixier and his mother for 2 months.
I'll be going with them to the airport tomorrow morning to say goodbye and wish them luck. Please continue to keep them in your prayers.

Training for a marathon

I love to run down here. It’s easy to get discouraged, and all too often, I find myself desperate for a break. My runs relieve any built up stress and help to clear my mind. I seem to get my best ideas when I’m running.

Seeing as how my runs usually take me through villages, I pass hundreds of homes and hundreds of families. The children run after me yelling “blan, blan” (white man), and begin laughing hysterically when I respond “M’ pa blan!” (I’m not white!). The older children usually stand on the side of the road cheering me on yelling out the little English they know, “How are you?” and “I am fine.” The adults shout out “bonjou” and “Sali,” (good morning, hello). It never ceases to amaze me the level of kindness these families show me. It’s as though they have nothing to be sad about. Haitians are a hopeful people, full of passion and pride. They continue to serve as my inspiration.

Last week when I was in Port-au-Prince trying to get the visa for Lixier, I met a woman at the guest house I stayed at who began telling me about a marathon in the Cayman Islands that’ll be held on Dec. 7th. I’ve always wanted to run a marathon but have always used my asthma as an excuse not to. Well, I decided to do it this time. I began training the day I arrived back to Les Cayes and have been running an average of 8 miles/day. Because of the unbearable heat, I can only run at dawn or dusk. The roads are rocky and the dirt paths are anything but flat. I figure that if I can train for a marathon running on small boulders that the real thing will be a piece of cake.

Teaching Summer English

Monday through Thursday, 8-9am, I teach begining English classes to 22 of the older boys and 2 girls at the Espwa orphanage. We started with the ABCs just three weeks ago and now they're saying complete sentences. I teach fully in English and only use Creole when I need to explain something more complicated or when I want to make sure that they understand. Every Thursday, they have a test on the material we covered Mon-Wed.

The classes are completely optional yet I rarely have a class that's not packed. The kids are desperate for knowledge and passionate about learning. Considering their lack of resources (text books, pens etc.) their work ethic is admirable and inspiring. For many of them, school work is the one and only thing they have control over in their lives. Studying vocab or solving math problems help them to put out of mind if even for an hour a day, the daily struggles they face.

When the bed bugs bite...

After examining the children’s houses, we discovered that not only were virtually every one of the beds infested with bed bugs, but they had also created homes and breading grounds through small holes in the walls. Just when I thought that I'd exhausted all possibilities for prevention programs at the orphanage, another one presents itself.

The purpose of this project is to sufficiently diminish, and hopefully eradicate, the massive bed bug infestation in the children’s houses. Bed bugs are well worth eradicating because their bites cause anemia and anaphalactic shock, and can transmit diseases such as Hepatitis B and Chagas, a blood disease caused by a parasite that leads to dehydration, organ failure, and anorexia. Bed bugs lay 200-500 eggs in a single batch, and can survive up to 140 days without feeding. They only come out at night, and when they do, they can bite up to 500 times without waking their victim.

The discovery of the bed bugs came at a perfect time. The goals of this project largely overlap with those of Houses to Homes (another grant project that is currently in progress at the orphanage)—plans to provide new beds, furniture, and paint are essential in addressing the bed bug problem, and are already in motion. This project proposes an added focus on clearing each house of infestation before moving new beds and furniture back into the houses. Starting tomorrow, my public health guys and I will be heading into the children's village to begin bombing the houses with insecticide and destroying all of the old beds.

He’s Dying, Why Can’t You Help Us?

Day 1-It was a week ago today when the founder of Pwoje Espwa came to me and asked that I help a 3-month old baby boy with hydroencephalitis get to the United States for emergency surgery. His name is Lixier and his head is three times the normal size. The pressure building up on his brain forces blue veins to pop out all over his head. His eyes are permanently fixed downwards and his cries are nothing more than whimpers. The slightest bit of sunlight or heat causes him great pain. His mother, a primary school teacher and major bread winner for the family, spends nearly every waking moment with him. An organization called the International Humanitarian Aid Foundation had arranged for the surgery at St. Joseph’s Hospital in New Jersey and found a host family for Lixier and his mother.
Day 2-I wasted no time in contacting the American Embassy in Haiti to schedule an appointment for an emergency medical visa. When I received no response the first time, I resent the same email in capital letters and with “URGENT” in the subject line. The Embassy responded within an hour of the second email. We were scheduled for the following morning at 11am in Port-au-Prince.
Day 3-Dan, the logistics coordinator, myself and Lixier and his mother boarded the 7am flight to PaP. The moment we stepped foot off the plane in Haiti’s capital city, the race began.
Several important documents that were needed for the visa had been sent to a hotel on the other side of the city for us to pick up before our appointment. When we arrived at the embassy, the guards at first refused to let anyone but myself and the baby into the embassy. Because I had made the appointment and the baby was the candidate for the visa, we were apparently the only ones approved to enter. After explaining the urgency of the case and showing him the baby, his eyes widened and he rushed us in without another word. Sure that we had all necessary documents, the Visa officer informed us that the infant would need a passport before a Visa could be issued. The mother had been told earlier that month that her baby didn’t need a passport. We’ve since learned that even a 1-day old child needs a passport to leave the country. At this point, it was a setback and nothing more. We had the child’s passport photo taken by a vendor on the side of the street, and hurried to the other end of town to the Haitian Immigration office to apply for a passport. Our driver, Garry, was with us the entire day, clearing the way, bargaining for lower prices and convincing officials that this baby would die if they didn’t give us what we needed asap. The immigration office turned us away. We had two more stops before we could even apply for a passport. We spent the day in the blazing sun walking through the slums of Port-au-Prince.
After a long and seemingly unbearbable day, we were approved for the passport and were told that it would be ready for us the next morning. The four of us stayed at a guest house in the city and had no problem sleeping through the night.
Day 4- We waited about an hour at immigration for the passport and once again set off for the American Embassy only to find out that they were unsatisfied with our documents and needed a few more before we could proceed with the application process. Now, four days into the process and still no visa, we began to get anxious. Lixier is worse off everyday and his mother is tiring quickly. Dan and I tried to stay positive, assuring the mother that we things will work out and that we needed just a few more documents. We left the embassy and made several calls to people in the states to have the missing documents sent over to the embassy via fax and email. By the time the documents arrived at the embassy, they were already closed. We would have to spend another night.
Day 5-We woke up early to be at the embassy when the doors opened. The necessary letters were in! The letter from the host family where Lixier and his mother would be staying pre and post surgery and the letter from the hospital stating that all costs will be covered by the hospital and that taxpayer money will not be used. I was elated. I looked to Lixier's mom and smiled. However, the smile didn't last long. Apparently, the hospital letter was signed by the Director of Physician and Hospital Affairs and not by the Chief Financial Officer of the hospital, which is what the visa application requires. At this point, I could not hold in my anger. I told the visa officer that this child will die if we don't get him to the states asap. I couldn't believe how picky they were being. "It's procedure," he replied. We snatched the papers back and left before I would say something I might regret.
While Dan was on the phone with the hospital in the states to try and get them to fax another letter asap from the CFO, I stayed with Lixier and his mom. We sat there in silence. I was afraid that if I said something to her, that she'd be able to hear the worry in my voice. The last thing I wanted to do was take away her hope. Sitting in front of us was an 8-year-old girl. The mother of the girl turned around and told us that her daughter had the same thing when she was born and that surgery saved her life. You should've seen Lixier's mom's eyes light up! "Isn't she pretty? Look how beautiful she is," she kept saying. I must admit, even I regained a bit of hope.
2 hours later, Dan walked back in with an expression on his face that gave me goosebumps. He had just been on the phone with the Director of Physician and Hospital Affairs to find out that the Director never wrote any letter for Lixier. It had been forged. The hospital had never officially approved the surgery! Here we were, sent out blindfolded with a mother and dying child, spending day after day trying to get a visa, when in reality there would be no surgery. The hospital has since called to session an emergency meeting to consider the case of Lixier and the forged documents. Now we won't know until this week, whether or not the hospital will do the operation.
The man who forged the letter is someone I know, a pastor, and the founder of the organization that was responsible for getting Lixier surgery. I don't know what was going through his mind when he forged that letter. Perhaps, he felt the pressure to get us the necessary documents asap and thought he would do no harm and that no one would ever know. The reality, however, is that Lixier is going to die without surgery and now the little bit of hope that was given to his mother and father has been ripped away. What this man did was not only illegal and unethical but immoral.
I haven't given up hope yet. I will see this man today and I have a few choice words for him. But in the mean time, please keep Lixier and his family in your thoughts and prayers.

Always with a smile

You see those spots on their heads? It's called tinea capitis, also called ringworm of the scalp. It's caused by mold-like fungi and mostly affects children under 13 years old. Prolonged infection leads to localized areas of swelling, raw skin, or pus filled lesions on the scalp. Most of our kids have it. It's cheap and easy to treat. One of the projects I'm working on is a mass treatment of all the children who have this highly contagious infection. The major obstacle is once again funding. Treatment for one child runs about $10. Let me know if you want to help.

It scares me how most people who've been here long enough, fail to be shocked by anything anymore. It seems they become accustomed to the daily struggles and injustices the Haitian people are faced with. What would happen if we were to stop being shocked by injustice. The answer is exactly what's happening now. Entire countries where people drink polluted and parasitic water, die of dehydration, eat clay biscuits and live on less than $1/day. This is the reality we live in. Yet, it's so easy to ignore when you're not waking up to children dying from hunger and mothers begging for food to feed them.

It's impossible to take a bad picture

I'm going to try and upload a pic with every post so that you can actually visualize some of the kids I'm working with and things I'm doing. That's a soccer ball made of string! You should see some of the homemade toys I've come across. Marbles made of clay, miniature animals shaped out of mud and left to dry in the sun, kites made of plastic bags and string from rice sacks, toy trucks made from plastic bottles, the list goes on.

I spent part of the day helping to repaint one of the children's houses. The goal is to repaint them all but the cost is pretty substantial. The concrete soaks up paint like no other and requires several coats. It costs about $350 to buy enough paint to do one of the houses and it looks like we'll be running short on funds. At first, I couldn't understand why we were even spending money on painting the houses. There are so many other important things that need to be done, things that the children actually need. But my mind was changed the moment I saw one of the little guys walk into the house that we had been painting a beautiful sky blue. His face lit up. The dirty dark gray cement walls are enough to make anyone depressed. It's amazing what the effect of bringing color into one's world can do.

My little guys

I'm so lucky to have these guys. No matter how discouraged I get with everything that seems to be going wrong, I can always count on them to keep me motivated and hopeful.

I went to Haiti's capital the other day to visit a man who I greatly admire. Dr. Bill Pape, founder and director of GHESKIO (gheskio.org) an organization dedicated to the treatment, prevention and research of HIV/AIDS and TB in Haiti's poorest city. GHESKIO's presence is massive, benefiting tens of thousands of Haitians every year and saveing countless lives in the process. It was a 4-hour bus ride to Port au Prince. I was up by 4am to make the 10 am appointment and had decided to go by bus instead of paying the $150 to fly. The bus was only $18 roundtrip, and was unlike any bus you'd see in the US. The buses here, though no bigger than a bus in the US, seats triple the amount of poeple. Crammed like sardines, it was airless, claustrophobic and and full of roaming cockroaches. I was happy to experience it though. Meeting Dr. Pape was a breath of fresh air. Here's a man who has dedicated the last 30 years of his life to helping his country and has made amazing progress. He has never lost hope in his people or faith in himself. He told me not to get overwhelmed, that a single person can indeed change the world and that Haiti is not a lost cause. He advised me to stay optimistic and idealistic because once you turn into a cynic and pessimist, it gets a whole lot harder to make change. I left his office, with a renewed hope that I can truly make a difference and that my efforts are worth making.

Donations

Several people have contacted me about how they can help financially with the work that I'm doing. The scholarship that I received to come here covers little more than my travel and living expenses. These prevention programs that I'm working to implement require significant funding. While grants help, they are difficult to get and require that most of your time be spent at the computer instead of in the field. Donations are the fastest and most efficient way to get things funded down here. Every week or so, I will compile a "wish list" for the program I'm working on. If you can help in any way, I would greatly appreciate it.
To donate, please send a check to:

THEO'S WORK, INC.
2303 WEST MARKET STREET
GREENSBORO, NC 27403
Memo: Will's Medical Mission

Contributions are tax-deductible in the U.S.

Wish List:
1. Sandals for all 650 children ($2,500)
2. Propane Fridge for the clinic ($2,000)
3. 100 tubes of Scabies cream ($1,000)
4. Mosquito screens for the 20 children's houses ($50/house)
5. Ringworm treatment for 200 children ($10/child)
6. Public Health van ($15,000)

Any donation helps.

"Mini Health Care Workers"

After my visit to the hospital, I immediately designated them as most in need for the stockpile of ethyl alcohol that I have. I went over two days ago to deliver them 1,200 bottles. It's no secret, the corruption that fuels the General Hospital and for this reason, I wanted to make sure that the doctors I had met the day before would actually be the ones to receive the alcohol. I had a few of the boys from the orphanage and Paige, (a long-term volunteer at Espwa who runs the ESL program for the kids among other things)to help me deliver the boxes. We brought them to Pediatrics, Surgery, Maternity and when we were just about to drop off a few hundred bottles at the laboratory, a hospital official approached me angrily saying that I needed to collect all of the boxes that I had distributed and bring them back to the main office where the "appropriate people" will determine who gets the alcohol and how much. I refused to recollect what I had already distributed and told him that he could do so himself if he was so inclined. He said that he would and asked that we put the rest of the boxes in the back storage area. I had him promise me that the alcohol would be distributed asap and told him which departments I believed to be in the greatest need from what I had seen during my prior visit. I warned him that if I came back in the next few days to see to find that the alcohol was sold or not given to the doctors to use that I would never come back with another donation for their hospital. He gave me his word and thanked me for the alcohol. I'll be visiting again on Monday to check up.

In an effort to build a network of clinics, hospitals and NGOs in the area, I've been trying to visit and travel as much as possible. Yesterday, I visited the birthing clinic (the best birthing facility in the area). The clinic is free of charge and provides excellent service. With about 1 child birth/day, the clinic is one of the busiest birthing clinics in southern Haiti(most women still prefer to have their babies at home). Cindy and Kyra are the two women in charge and were excited about having an established network among clinics to make it easier to refer patients etc.

Yesterday, I started training one of the older boys at the orphanage to be my right hand man. He is going to help me implement all of the prevention programs that I've drafted, including the nutrition and hygiene programs. I'm currently briefing him on the details of the programs, which includes teaching him about the diseases themselves, prevention and treatment. Together, we will both begin training some of the older boys who are interested, to become our "mini health care workers." As health care workers, they will help with teaching health education classes, mass treatment programs for scabies and ringworm, and daily surveys of the living quarters looking for health hazards, accompanying children who are sick to the clinic and making sure that the children on TB and Malaria meds are adhering to their regimens. Paul Farmer had it right when he said that the only way to make it sustainable was to teach Haitians to treat Haitians. It won't happen over night. This is where my patience will be tested. I'm excited to get started.

The worst day of my life

This is no exageration. Never in my life have I experienced or witnessed such pain and suffering as I did today, a day empty of hope and full of despair. I visited the General Hospital in Les Cayes today. This is the only public hospital in the city. I don't know how to begin, so I'll just write the first things that come to mind. Forgive me if my thoughts seem random.
There weren't enough beds for the patients. Mothers stood by the bedside of their dying children. Children fanned the flies off the faces of their dying parents. Most of the beds were nothing more than a sheetless and filthy 2inch thick mattress resting on a rusty metal frame. The smell of death filled every hallway and every room. The pharmacy was no bigger than a closet, full of rusted metal shelves only half full. The AIDS ward is an outside area of benches where the patients are left to sit away from everyone else, awaiting treatment they were promised but will never receive. The pediatrics ward was the worst. Children who are so starved and malnourished that their bodies have given up. Babies who were born only to die a few days later. I can go on and on but I'll save you from the details. I don't know how much longer we'll have electricity.
I find myself praying daily. The prayer is always the same. God, give me the strength to aid the weak, the poor, the sick. Guide me to the darkest corners where the suffering is unimagineable and help me to brighten them. That I never forget what it feels like to see a child die unjustly before my eyes. Give me the strength to fight and never lose faith. That I make the right choices and never lose sight of myself. Amen.
I'm exhausted, but I can't sleep. What I see, haunts me. It's impossible to forget. Once you've seen it, you've lived it, and that's unforgettable.

One thing at a time

A lot happened this past week. We closed the clinic for three days in order to do a complete inventory. We stayed open only for emergencies of which there weren't many. A boy with a swollen and infected toe the size of a water balloon, a child with a gaping head wound, another with his ear cut in half and an 8-year-old with a 14-inch razor blade cut down his arm that needed 22 stitches. I spent most of the week sorting out expired meds and emptying a 20-foot trailer filled to capacity with hundreds of boxes full of ethyl alcohol, and pill & syrup containers of all sizes. It took all morning and part of the afternoon to sort and count everything. A donation totaling more than 9,000 bottles of alcohol, 2,700 pill containers and nearly 10,000 syrup bottles. A bit much for our small clinic, but a perfect opportunity to build relationships with nearby clinics and NGOs by offering them some of our extra supplies.

Since we are in the middle of nowhere, it is difficult to get and keep electricity. It's been better these last few days because we've installed some car batteries that can give us juice when the electric company shuts off electricity. They pretty much get to decide when they want to give us electricity and sometimes it's only for an hour or so in the middle of the day or randomly at 3am. The batteries are working great. We've had electricity 24/7 for the last two days. We don't have a fridge in the clinic yet (I'm hoping to raise the $2,000 to get a propane fridge that would be best for storing the vaccines). I currently have no place to store any vaccines so I've just been putting the PPD vials in a cooler with ice packs for now. We need a fridge asap, especially to be able to give out tetanus shots which the children desperately need.

Their are 640 children here and while the 150 who are either orphans or homeless, stay all year round, the others go back to their desperately poor families for two months of the summer and return for school in Sept. The way we have the TB treatment set up ensures that the 9 month regimen is complete before summer break starts. We identify all of the positive cases (what I'm doing now) and when the other docs come down in Sept., we will start treatment for the people who need it, that way their regimen is over by mid-May-early-June. The regimen is one pill everyday for 9 months. People in the US can't even adhere to such a regimen. For this reason, the house monitors (house mothers in charge of each of the 20 children homes) are responsible for distributing the meds every week to make sure the children take them. The older children and adults that don't live in the same area as all of the other children have no one to monitor their adherence to the regimen. The plan is to start DOT for those older people receiving treatment in order ensure adherence and prevent multi-drug resistant TB (MDRTB).

Most of the children have serious cases of scabies and ringworm of the scalp (tinea capitis). It is an enormous burden that can only be lessened by treating all of the children at once. The problem is that we only have enough meds to treat a few dozen of the children at most. Currently, we've been treating the children individually as they come into the clinic with scabies or tinea but this has proven to be ineffective at controling the outbreaks. Both of these infections are highly contagious and are difficult to prevent when only some of the children are being treated and all are sharing 3 or 4 to one bed. This isn't to say that there is nothing to be done if we can't get the meds. I'm drafting a plan for the control and prevention of the two infections and believe that we can drastically reduce the incidence of both by taking a few simple preventative measures. There's a lot to do. I'll post the abstract for the plan when I'm finished.

Blackout

After several days of nearly no electricity, I started to worry that my days would have to end when the sun goes down. I've had to use my flashlight to read and write and am now almost out of batteries. Life is slow here and without electricity it is unbelievably slow. I was warned by many before coming down here that things don't happen over night and now I understand all too well. After 1 week, I've only been able to locate 7 of the 45 children and adults who need TB tests and it took all morning to find the same 7 so that I could read their results and determine if they tested positive or negative.
I just signed on to teach an English and a Spanish class for about 10 boys this summer and I'm starting my first ballroom dance/latin dance lessons this evening for all the children. They keep asking when I'll teach them, so I'll surprise them with it tonight.
That's all for now, I've got a scabies and ringworm prevention program to write up.

The Malaria Plan

At 2am, I finished the first draft of the Malaria Control and Prevention Program proposal! I expected it to take me at least a week to put together the 9-single spaced page proposal but after visiting the living quarters of the children yesterday, I was moved to do it in a single sitting. For the first time in my life, procrastination was not an issue. When I visited where the children stay, I met all of the house monitors (monitrice). There's one middle-aged mother-like figure in charge of each of the 20 homes. They are all roughly the same size, and hold anywhere from 17-46 children in each. There aren't enough matresses or sheets and the open cuts in the walls that act as windows for ventilation, do little to stop bugs and rain from entering the home. Carol, the monitor of the first house I visited, volunteered to take me around to all of the other houses to meet the other monitors and see what each home looked like. All of them need something. It' s so easy to get lost in all that needs to be done. The truth is, it's impossible to focus attention in just one area when even the most basic needs of the children are not yet being fully secured. We are short by $4,000/month, what it costs to provide the supper meal for the children. Without this meal that only costs US $0.24/child, the already malnourished children will be forced to go 17 hours between meals. With that, comes weaker immune systems, the onset of more sicknesses such as malaria, worms, dengue, TB and HIV. It's a vicious cycle that can only be stopped by attacking its roots.

Here is the abstract for the malaria program I've drafted. Please let me know if you know anyone who may be willing to help fund the project and or any opportunities for grants etc.

The primary objective of the Program will be to reduce as much as possible the health impact of malaria on the population of Vilaj Espwa and neighboring villages. One of the many goals of this prevention program will be to develop a model system for malaria control that can be applied throughout Haiti, where the disease is endemic, and that would be applicable to both children and adults. As our primary setting is contained, it is an ideal environment for this type of project. Data collection, medication administration and follow up can be assured. The malaria prevention program strategy will focus in on three areas. The first is case management (diagnosis and treatment) of all persons suffering from malaria. Malaria is often a debilitating disease that, when caused by Plasmodium falciparum,(the strain found in Haiti) can be fatal. Directly Observed Therapy (DOT) is indicated for all persons being treated for malaria and will prevent the onset of drug-resistant malaria. The second area includes the prevention of infection through vector control. Some vector control measures that will be undertaken include the destruction of larval breeding sites, insecticide spraying inside houses and insecticide-treated bed nets (ITNs), which combines vector control and personal protection. The above strategy will be applied through several components aimed at controlling this endemic scourge, including the development of a malaria case registry, the provision of anti-malarial drugs, provision of equipment and supplies (e.g., microscopes, drugs, bed nets), expert consultation from both local health care providers in Haiti and physicians from the US, disease reporting and surveillance, intensive training of the Espwa clinic health care workers on malaria diagnosis, treatment, follow-up and health education, where the communities are informed of what they can do to prevent and treat malaria.

Where to Begin?

Yesterday was a busy day. First thing, I brainstormed several ways that I could maximize the usage of the few meds that we have in the clinic, especially those that are in high demand such as those used for treating ringworm, jock itch, fungus, scabies etc. The children will be leaving school soon for the summer and the orphanage will be down to about 100 kids during the summer months. This will serve as a perfect opportunity to sterilize and better equip their rooms to prevent against increased exposure to diseases such as malaria. I'll be heading over to the homes today to take note of things that need to be done.
I'm having 500 Haiti bracelets made that I'll be bringing up with me in August to sell so if you'd like to buy one for $5 please let me know. The money will go towards the cost of making and shipping them, the arts and crafts program here at the orphanage and towards my work on infectious diseases.
Dr. Cynthia, the medical director at Espwa, added a few more duties to my to-do list. These include, coordinating along with the TB program, a malaria control and prevention program to put into action immediately and write up as a grant proposal.
Starting the case registry for all of the children, has already proven more difficult than I anticipated. The food riots and manifestations that just happened in Haiti, put everything at a standstill including the country's healthcare and with that, medical records were discontinued and now the latest information I have on the TB drug regimens is from January of this year. the last 3-4 months have gone unrecorded. Currently, the 640 or so children at the orphanange are split up into one-room concrete buildings with several dozen in each. They share 4-5 to a bed and have no screens on the windows or bednets to protect them from the swarms of mosquitos that come at dawn and dusk. Malaria is like the common cold here, but that is not to downplay how terrible of a disease it truly is. Muscle pain, nausea, headaches, diarrhea, dehydration, neck and back pain, fevers, chills and blurred vision are all symptoms of Malaria. This is a completely preventable and treatable disease, but because of the lack of resources (mainly financial resources) we're forced to watch these kids fall ill and suffer unjustly.
There is so much I want to write but never enough time to do it. I feel guilty sitting at my computer, knowing how much has to be done. I've decided that the best way for me to go about getting things done day to day is by setting a large number of small goals each day so that something is always being accomplished.
Today's goals:
*Inspect children's living quarters for areas of concern regarding malaria prevention and draft a proposal and prevention plan
*Meet with the Assistant Director of the orphanage to try and develop an updated list of all the children so that I can match their medical profiles and or start one for them.
*Question people about the missing 50 dose PPD vial that is gone from the storage refrigerator. We still have roughly 45 children who have yet to be tested for Tuberculosis and I need the PPD serum to do so.
*Create a more user-friendly database for INH treatment and begin entering the treatment numbers for the 350 or so children who tested positive for latent/active TB over the last two years
Ok, so maybe these aren't necessarily "small" goals, but I'm feeling the time crunch and the to-do list continues to grow...