Coming home

“These feet have walked so many miles/ and on so many continents. Still this heart is beating wild/ as yet of no great consequence… So many miles… The fortune teller isn’t right/ it’s scary but it’s glorious.” (Sarah Slean)
Coming home from a 3-week time away, working or not, is always bittersweet. I love slipping back into the familiar (and so appreciate the comfort of it) and at the same time have such a different perspective on my life that I feel a bit detached from daily life for a while. The contrasts with Haitian rural life are as stark as they were last time and the generalized wealth (not necessarily of individuals, though there is that too) of Canadian city life is such a contrast to the poverty I have been experiencing. This time, I’m even more conscious of the contrasts because I’m thinking about the choice my friend has made to return to Canada only temporarily before moving to Haiti permanently in just a few months. She is clearly joyful in her Haitian community and content in her decision and I am really happy for her sense of conviction about what is right for her at this time. I’m awed at the same time by her willingness to extend that to completely changing her lifestyle and to leaving behind so much I take for granted, including climate, access to healthcare, an income, etc. And I know she’s in good company, having met a number of people who’ve chosen the same. I’m enough in love with the beauty of Haiti to find myself drawn to job postings for NGO midwifery jobs and to be planning my next trips but the permanence she’s embraced is very far from that. I think I will be content for now to be committed to keeping a stronger awareness daily of the Haitian people and struggles they have, as a particularly stark example of inequality in our world. I will keep reading, both newly-discovered Haitian history and authors, as well as the eloquent writings of people like Paul Farmer who are doing on the ground work that I admire. And, I will keep figuring out how the work I’ve loved doing these past weeks fits into my world that is so full already: on-call Canadian midwifery work, teaching and outreach, singing and being outside, friends having babies and getting married, life in the big city. Until next time, take good care,
Jenni

 

My first mariage proposal

I expected many new things and new experiences going back to Haiti, but I didn’t expect my first marriage proposal. Okay, Maxendre (a friend of Mackenzy’s) was maybe half joking and he definitely only said it because I was younger white woman, as it was the fourth sentence out of his mouth after ‘what’s your name’, ‘can I have your email address/phone number’ and ‘are you married already’! I have had the other questions many times now, from both young boys and older men (the midwifery students also all wanted to know my age and marital status) but it hadn’t yet proceeded to a marriage proposal with anyone else. It was quite amusing, when I got over being thoroughly annoyed and feeling cornered by the fact that he was a large guy (many Haitian men are not that much taller than I am) and that he was ostensibly escorting me through the brush from the garden back to the house, I having never been that way before. Luckily, I had a witness, another guy from the garden giggling the whole time, and felt like I could finally ditch him when I arrived back. When I told the story to my hosts, I realized a couple of things:
- firstly, that it does still annoy me to always be the ‘blanc’ and to be singled out for that and constantly asked for things, including passage to North America by way of marriage
- that my conviction that I’m not saleable goods whether I’m in Haiti or elsewhere is totally reasonable, and that doesn’t have to change
- that I could pretend to have a partner (read husband) but I prefer honesty, even for the occasional uncomfortable situations
- and finally that ultimately I should get used to it and find a graceful way to hear it but not respond, as it still happens to friends who have lives in Haiti and Haitian partners. I like the socialising that I’ve been doing this time and don’t want to go back to isolation, even if that means that the social codes are harder to negotiate and figure out. By the way, Mackenzy thought it was completely unacceptable and apparently gave his friend a very hard time about it, AFTER he finished laughing his head off.
My other firsts in Haiti this time included:
- first time in Haitian public transport (both papadaps and a taptap, though the taptap was a friend’s who took us to the airport and had to wave down all the potential paying customers along the way)
- first boullie, a boiled pudding made with grated plantains and sugar, and usually lots of milk. It’s a traditional dinner here. I ate it for breakfast.
- first time resuscitating a baby in the cab of a moving pick-up, travelling the very rocky roads surrounding Hinche. I don’t recommend it.
- first time eating bitter melon (I think, I don’t remember others) – it’s a very traditional Haitian food and not too bitter.
- first time peeing in a place where the puppies were so thick under foot I had to chase them away before I could go, and they still watched me the whole time. (Even the dogs stare at the ‘blancs’ here, eh Gillie?)
- first long-distance motorcycle ride (over 70km – my tail bone is still sore 4 days later),
- first time swimming at a watering hole with donkeys and cows and motorcycle washing all together, as well as first time swimming off of a garbage dump (though both places were much more safe than they sound – lots of quick moving water and no floating garbage though I wore good shoes. Most water sources seem to become adhoc garbage dumps here if the garbage is not burnt), and,
- definitely the first time (outdoor) showering with turkeys (full-grown they come up to my mid-calf but are luckily very meek).
That feels like enough new experiences for two and a half weeks!

 

The systems we participate in and manoever around

Living in rural Haiti, even for just a few days, as well as the two weeks working within the public healthcare system, I’ve been learning even more about the systems here that frame how people live, get food and stay healthy (or not). Watching Mackenzy’s deep commitment to his country, his love for farming, and his impassioned educating of everyone, and then how many challenges he faces in creating more access to good food in his village, it seems like nothing can change. Everything from the electricity that is supposed to run when paid monthly but is not available because somewhere up the line someone hasn’t paid for the gasoline generator, to the distance everything (for example repair parts for their irrigation pumps) has to travel by roads that are SUPPOSED to be finished at some point (but who knows when), to the numerous hoops they have to jump through on every level of government and society to obtain more land. Mountains beyond mountains. Yesterday, we visited the catholic priest here in the village so Mackenzy and Kirsty and their team could convince him to support a general community garden (because people don’t really trust the project until the priest okays it) and a community teaching garden at the local school which (I believe) would be on church-owned land. After an initial meeting of a couple of hours, they now will go out and visit the land together, then write up and sign a contract and then try and get the school on board for this next school year. This is a project that’s been in the works for at least a year! I guess it is a reasonable time frame for a similar project to get off the ground but it seems so slow when there is so much energy and momentum now and they have had to turn away people for lack of work. As well, there are so many NGOs working on supplying food here, though few that I’ve seen who are working on making sure people have long-term access and the knowledge to grow their own food. The gendered society certainly contributes a lot of extra challenges. There don’t seem to opportunities for single women to own land or run businesses or even work outside of the home in rural areas, other than to sell food or clothing by the roadsides, a relatively unreliable income. There is a high percentage of women-headed households and children frequently live with their mothers, often without support from any father-figures. The rural women I’ve seen in the mobile clinics or at the hospital, and even the students in our program seem to be very limited by their gender socialization in terms of accessing upper-level schooling or training in trades, with a few exceptions. I know that the projects of micro-credit in the mountains have been empowering women in starting their own fruit transformation businesses but the schools don’t seem to value educating girls beyond elementary school. The political system seems to reflect this gender bias not surprisingly, and, though one of the two candidates in the presidential run-off elections is the only woman (I believe) from the original list of over 50 candidates, many people with an opinion said that they wouldn’t vote for her because she will be ineffective simply because of her gender. This despite the fact that her main rival is a popular singer with very little experience in politics. Her presence is significant on the radio and in the streets in both posters and banners. I hope that means that some are thinking differently. The young women I’ve talked to (of course with some exceptions) seem to have less conceptual and overall analytical skills than guys the same age, and learn more by rote. It seems like this may be one of the barriers while adapting different midwifery curriculums to the Haitian setting; not to dumb down the information but to figure out how to teach those analytical skills to women who haven’t had as much experience as their male contemporaries thinking and learning that way. Especially as the goal is to have the graduates working independently and for some even to set up their own birth centres/ mobile programs. As well, included in the gender piece is the healthcare setting, which is culturally very top-down authoritative and the authorities tend to all be male, as far as I’ve seen. I don’t know how reflective that is of health institutions in general but there is a sense of everyone towing the line (whether that is the fallacy that there is always enough medication for all patients in the maternity area or that the pride of the institution gets in the way of patients getting proper care by refusing to accept that others may be doing a better job in some areas). The couple of difficult situations we had working within the hospital highlighted for me both the internal, particular challenges that the organisation (M4H) faces having chosen to work in this community as well as the incredible challenges of different organisations trying to partner with each other and support the public health care system. For example, a different organisation (an American NGO) that funds a good portion of the hospital staff also provides medications through a depot. Unfortunately, the way the hospital pharmacy is stocked is that they have to put in daily requests and frequently, stuff goes missing (on the way from the depot behind the hospital) or they don’t order enough and they run out, including of basic supplies such as IV fluids and antibiotics. Often, the depot is not open for restocking by that time and the individual departments (such as maternity) can be low on stock themselves (as they are also supplied through the same system). However the hospital finds it difficult to change the system because then they would have to admit to the donor organisation that not all the patients are getting the medications they need while in hospital, even though that’s their commitment. Our organisation works within the hospital and attempts to advocate for better systems, as well as pays for midwifery staff and brings in donated supplies when there are none. Still, there are women (and babies) very, very sick because of lack of either pregnancy care or spotty or unavailable services once they reach the hospital. It’s a really complex set of challenges!
This trip, I’ve also been seeing more how work happens on an organisational level within M4H, beyond the day to day teaching and clinic work of the volunteers. In any organisation, making and supporting funding and partnership connections needs to happen both at a broad organisational level and on the ground and it does, for example this week I was interviewed by a film crew from the Rotary Club who were documenting our work in distant mobile hill clinics after partially sponsoring the new jeep for accessing those communities. For the jeep, even the incredible barriers at each level of government to get it through customs and on the road, as much as the need for it is so clear. So much legwork, and so many pieces to be thought through, like if someone is offering to partner on building projects is the priority a birthing centre or more high-risk facilities, and how do those fit with the goals of the organisation over all? This all has to happen while supporting the work of 3-4 volunteers a week, 40-50 weeks a year, just at the one site. I was trying to help with that while I was there for two weeks also by translating from French the notes that are made in hospital and clinic charts so that other volunteers can read them and so that we can make sure the new students are learning how to write accurate and complete notes as they learn so much from the staff (nurses and graduate midwives) already working at the hospital. I also used my experience working with interpreters (and my French) to develop some norms to begin to try and evaluate and standardise the interpreting services, so vital in an organisation that works with volunteers the majority of whom don’t speak the language (like so many other NGOs in Haiti and elsewhere). Again, there is a gendered piece as there are fewer available experienced female interpreters (partly I think because women are less likely to be studying English or working at a higher level in that language or in French). At the same time, there is an absolute rule about no male interpreters in the delivery room at this hospital (and more generally culturally I’ve heard, a double-standard as all the OBs seem to be men). So, for both cultural reasons and for practical reasons, this small organisation with few on-the-ground resources needs to develop and maintain good interpreting services, both men and women. Our team became pretty passionate about it, especially as it touches so many aspects of being advocates for women. If their health care providers (or some of their mentors/instructors in the case of the student midwives) don’t speak their language they get (and give)less good care. It’s something I struggle with in Toronto too so that part at least was rather familiar.

 

could i have some more (vegetables), sir?

I’ve realized how hard it is to find vegetables when poverty combines with a recent cholera epidemic and chronic food insecurity! It’s not that we’ve eaten extremely bland foods, or even the same thing every day, both here and in Hinche. However, the starch content is high — potatoes, sweet potatoes, plantains, rice, mais, and pasta(?) in different forms at every meal — and the protein options few and not really what I’m used to. Since I’ve been here in Petit Trou, we’ve had lots of tasty fish but in the mountains it was almost exclusively goat and pork, with a bit of salami. Having not eaten meat regularly from 14yrs old until about a year ago, I have been making myself eat it when I can. I did have eggs (though many of them already fertilized) and they have a lot of beans in rice or in soup form to go on the mais, though I end up eating more food than I would normally eat to get enough protein and it’s all highly salted. I’ve managed, especially with the incredible peanut butter we were treated to in the house in Hinche – organic, local peanuts roasted by our cook Duny (who also roasts the best coffee!). That with the local ‘bananes-figs’ (bananas) has been an unexpected and wonderful treat. The local tomatoes are quite lovely also, and we sometimes manage to get dishes with spinach or watercress-like greens in them (almost all the greens are cooked, especially since the cholera). As well, there are tons of a type of grapefruit called chadek in season and everyone makes them into juice (which has been my mainstay for the last two weeks, especially when I was sick) and marmalade. The starches are tasty too (if very salted) and we all gobbled up the ‘fritay’ at the Maison in Hinche, including deep fried potatoes and sweet potatoes, and fish-oil-fried fritters. Luckily it always came with the one raw dish that is common here: called picklies, it’s a mayonnaise-less version of cabbage salad, with carrots and citrus and hot peppers. That and the cooked beat and carrot salad that appears once a week were definite highlights for me, as was cooking with parsley bought at the local market. It helped me find alternates to the white bread and pasta (including mac and cheese!). It does make me appreciate how accessible green vegetables are in Toronto, even if they seem sad and are so expensive in the winter. As Gillie said this week, I could totally be in love with Haiti if I could eat a little differently here! I am in love with the beauty of this country and try not to let my white, North-American expectations get in the way of feeling comfortable here. My stomach is coping so far!

 

and travelling to…

My first experience in public transport in Haiti! Thank god for Mackenzy who met me at the end of the drive from Hinche. We took a crowded papadap (van sized with twenty people on barely padded benches) with the luggage on the top from Port-au-Prince to Miragoane and I alternately dozed and watched the beautiful little 8month old in front of me with his tufts of fluffy hair floating above his head in the breeze from the windows. Initially however, I was fascinated by the people crowding the cars at every speed bump. They sell everything: cell phone minutes, bread, a sort-of odd patty made from vegetables and spices, water packages, and cold drinks sweating water into the open windows. They were present (and persistent!) until west of Leogane (about an hour and a half from PaP) where the concentration of houses started to get less and people were more occupied off the road than on it. Tons of traffic the whole way though!
We got off at Miragoane to change to the moto and I was very amused (and pleased) by
the careful arrangements that was getting my bag on the back of the bike. Getting the three of us also on there for the 70km ride was a different story. Sandwiched between the two guys (Mackenzy and his friend who drove), it definitely seemed to involve a combination of yoga and circus contortions, pretending I had no bones and can bend every which way, and also be strong enough to hold myself on, insisting that I really weigh nothing at all! My sit bones are still remembering every rock. However, the ocean views much of the way made up for it and in some places we ended up driving directly on the dark beach sands as well through two or three feet-deep rivers in from the ocean. It was definitely an experience driving through the palms and arriving at sunset at the small house of Mackenzy’s family with so much dust in my eyes I couldn’t really see as everyone was introduced to me. I’ve still got to learn the names of the little ones (he has nine brothers and sisters and I’ve been introduced to at least 5 other people – feels right at home!) A beautiful dinner of fish and plantains and potatoes awaited us after washing and, after driving all day, we definitely needed it all. Because of the lack of electricity in most of the village (at the house here they have one small solar panel only), the stars are amazing and the ocean is only 150m away. I’m looking forward to visiting and exploring tomorrow. Such a short time here!

 

Riding away

I’m feeling no less heartsore but it’s starting to be less raw today. Riding away for me is about getting close to leaving this lovely community and all the incredible experiences I’ve had these weeks, as well as referring to all the travelling around I’ve been doing here. Both weeks I have been on the mobile clinic team at least one day and I’ve loved it. Despite the ever-present and ubiquitous dust, I like travelling in the benches of the open pick-up truck (second time was a land cruiser following the new pink jeep!), mostly because it usually means we’re leaving town for the beautiful hills of the Central Plateau. We leave town through the streets in the lower half of the market area. That part of town is thick with motorcycles parked 5 deep on the roadside and multiple vendors who lay out their hinged wooden display boxes so that they seem to be floating on the side of the road, sometimes perilously close to passing vehicles! The river also runs through the east side of town, and arriving back into town at sunset (both from one of the mobile clinics and from the waterfall trip we did one day) makes the whole ride worth it as the warm light bathes the river and the small figures all down it with this orange-purple glow. Crossing the river on the way out, however, we take a sharp turn straight up and procede in to the steep hills along the road that is basically masses of dusty, bare rocks that form the road (my bruised back knows them intimately), lined with trimmed cactus hedges and barely wide enough to admit the truck and a motorcycle and 2 donkeys trying to pass each other at the same time. The road dips down occasionally into a green valley and the truck or the jeep trundles through the usually metres-wide river at the bottom, spraying the muddy water everywhere as the locals who’ve gathered to wash (their kids, themselves, their motorcycles) stare after our large beast and the blancs holding on in the back. All the drivers honk continuously also, as blind corners are every corner and because so many animals need a little encouragement to get off the road. During yesterday’s 2hr drive each way, we nearly ran over 3 chickens (tail-feathers under the wheels!) and a rooster, at least 2 donkeys turned sideways in the road as their owners tried to guide them with palm fronds, and various oxen, nevermind the small children. The land cruiser and trucks travel indiscriminately back and forth across the road, and frequently with little success at avoiding the larger rocks. The views are worth it, however. The high cactus barrier will break away all of a sudden, and beyond the yard of the thatched or tin roofed wooden house, you catch a glimpse of the hills, spots of green showing the occasional water source, but mostly orange-yellow rock cliffs with tropical plants clinging to the tops. Off in the distance you can usually see a lone house with a yard and maybe a donkey or horse with the characteristic U shaped saddle. It seems so remote but people come out of everywhere: children of all sizes in their school uniforms in checkered primary colours, women carrying a bucket of water or a large package wrapped on their head, or men in women’s hats (complete with feathers) with machetes or moving hitched oxen along the road. It’s marvelous and the poverty and lack of access to food and water is so stark.

 

my heart hurts

A sense of loss feels so pervasive tonight. Miscarriages and stillbirths all around, deathly ill women going without needed antibiotics, and to finish the day we resuscitated and then held a preterm baby as he died for lack of oxygen to transport him to a higher risk centre. It’s not fair that his mother nearly died (of preeclampsia, like our other woman), it’s not fair that there was limited oxygen available, it’s not fair that there was an ambulance for transport (our second attempt) but no oxygen regulators, and it’s not fair that the chances this baby got to live were so much less than such a baby in most of North America, and that this happens so frequently in this beautiful country. I am heartsore tonight.

 

and in all that leisure time…

Salsa dancing is not something I associate with Haiti. Having taken lessons on-and-off for 4 years in Toronto however, I know salsa music turns up in the oddest of places. So I really shouldn’t have been surprised to find myself at 8pm for the second Sunday in a row listening to African-inspired music with a salsa beat and the occasional english lyric, as well as home-grown Haitian salsa also! And not just listening to: there is quite an active little salsa community here in Hinche of which Reina, one of the resident instructors and housemates, and her partner Blada were my entry points. It’s not a big scene: mostly Friday and Sunday nights at one local bar of 40-50 tables and some scattered dance classes, the crowd consisting of 10 really strong couples and a lot of other observers. The outdoor club was packed last night but the covered, spotlit ‘pavilion’-type dance floor was sparse for most of the evening, other than the pop salsa songs which reminded me of a grade 8 slow dance in terms of how interesting they were to watch. The black light lit up the wall murals beautifully (and my fingernails) however, and was quite lovely with the absolutely stunning night sky here last night. Otherwise, the people who did dance were quite good and many were excellent, including Reina and Blada who dance a very flashy LA style with lots of shines and dips. Despite being somewhat intimidated by the collective expertise and bright lights, I ventured out a few times, mostly dances with folks from the one other table of non-Haitians; the UN staffers. Both nights, I’ve danced bachata with the few Haitians who’ve asked me. I felt shy about soliciting dance partners, not because of the men-women dynamic (lots of women initiate dances) but more about being white, another way in which it complicates what could be a fairly straightforward social interaction. I’m just not sure what people are expecting of me or how they’ll react, normally or especially when I do something even I know is outside of social norms here, like dancing with Reina. I’m not easily intimidated however and really enjoyed myself. It’s a great chance to also sit in a dark bar and watch the well-dressed folks go by and imagine that I don’t stick out quite as much as I actually do.
Sunday turned into quite an active day: riding house bikes 40min out of town (on pure rocks and potholes) to the home of our house manager. The collective we (the volunteers and staff) are participating in the prenatal care of his wife, who is in nursing school and expecting her second baby. Their healthy two-yr-old boy giggled and played around us in their one-room wooden house as we (another volunteer from Virginia and a staff person from Boston and I) did her relaxed prenatal visit. Afterwards, we wandered nearby to the retreat house of the two Xavarian brothers who teach in the orphanage, and were introduced to their rabbit breeding project (just started, for food of course) and their lovely little garden of eggplants (common here), squashes (called militons and cooked in everything) and okra and tomatoes. It’s a beautiful spot, originally built to hold the brothers who first began a community outside of Hinche in 1985. The hibiscus flowers were blooming, the mango trees had finger-sized green mangos on them, and even the bromeliads had flowers, as did some of the cactus. It feels like such a winter respite being here, and only occasionally too hot to think or move around. Mostly, it’s cool at night while the sun warms things up around 8am and by noon it’s quite hot – 32-34degreesC. Cool showers have been a must with all the dry, dusty roads and sweating temperatures. Our final time for exploring the countryside will hopefully be a trip by truck to the waterfall about an hour away to swim. It will be wonderful to be near water I can actually enjoy, as the river here, while 2 minutes down the road, also serves as the local laundry, sanitation unit, and dump, and is therefore clearly not safe. I wasn’t even expecting to swim but am going to take every opportunity.

 

Contrasts and contradictions

I’ve come to realize an incredible contradiction in my work here. I practice and consider my expertise in the area of low-risk, healthy pregnancy, working primarily with women who have physiological labours, who want to avoid interventions but who occasionally need them and then they are used in a careful, thought-out, appropriate way. This doesn’t mean that every woman wants a home birth, or wants to avoid an epidural at all costs, but the safety net of (usually) prompt access to interventions allows women to make significant choices in how and where they birth, in other words they can choose low-intervention care because of the existence of high-risk referral services. One of the goals of Midwives for Haiti is to provide education to birth attendants that models that approach. The care that women most often get (if they get any) is compartmentalized and contradictory, where some women get interventions for unexplained reasons and others get none when they need them. Working within the hospital setting, I find I have to advocate for physiological positions for labour, for a minimal amount of monitoring to establish such diagnosis as ‘fetal distress’ (a reason many women get potentially unnecessary cesareans in lots of different settings, not just here), AND for more medications and prompt interventions for women who have quite serious conditions, like the woman we have become quite involved with who was seen in the hill clinic with very high blood pressure (230/160) and a smaller than normal baby. With high blood pressure like that, she was at extreme risk for seizures and other complications so we needed to get the baby born as soon as possible, to decrease her risks and to increase the chance of the baby surviving. That’s an extreme case, obviously, and I was surprised to see very little of a sense of urgency when she arrived at the hospital. Of course, we did have 4 other women in the delivery area but that itself was a bit contradictory as one of them was completely well, just recovering from an abortion. She had taken medications on the street to start an early pregnancy abortion (apparently a very common practice as abortion is officially illegal in Haiti but caring for women who have what we call an incomplete abortion is not) and had a bit of extra bleeding but was fine by the time I arrived at 9am yet lay on a delivery table until noon. What she seemed to need was a bit of reassurance/education and some basic monitoring to make sure she wasn’t losing too much blood, but certainly not to be on an uncomfortable delivery table in full view of another labouring woman who was much more urgently going to deliver (a breech baby and her waters had broken at 34weeks). I think I’ve mentioned this before but the basic care for labouring HIV positive women is also not there (though there are extensive programs for pregnancy and preventing mother to child transmission after birth right next door), nevermind simple, compassionate labour monitoring and birth care for these women. I was at the Partners in Health hospital in Cange today where we had taken (by truck an hour through the mountains) the tiny baby of the severely preeclamptic woman because they have a neonatal intensive care unit. The hospital where we work has no NICU and the pediatrician wasn’t even available to see the 1.9kg baby with a heart arrythmia and severe cleft lip and palate I helped the mother birth earlier this week. When I went to see her two days after birthing (the first day I was helping her feed the baby for the first time since birth), she was preparing to leave the hospital having not seen a pediatrician at all, despite mine and others’ repeated requests. The ENT surgical repair team will likely come in March and hopefully she will somehow access a consultation for her baby.
The hospital at Cange, described very eloquently in the book Mountains beyond Mountains, is an hour away, still in the same region, yet worlds away in terms of care practices, innovation (particularly in care for people with co- HIV and tuberculosis infections), and sheer determination to be not mediocre but really good at providing comprehensive health care. The public/private piece is a significant piece of what makes it different (the level of corruption in the public health systems is unbelievable) and there are many others. Whatever the difference, the oasis of cleanliness (and clean water), order and documentation, and professionalism was a welcome sight for these sore eyes. Having not been a patient there I don’t know exactly how it is, but it made me think again about how things could be done, even with the limited resources this region has. So, back to the contradiction: how to keep my expertise in low-risk, physiological care (for home, and so that I can model that for the students here) but hold both those areas of knowledge so I can at least triage and access care for high-risk women here when that care may not exist for them, or their babies. Someone has to provide them with care.

 

goats in the road

The goat would just not get out of the way. Planted firmly in the road, head down as far as it would go and horns sticking out towards us, the tan goat with darker brown patches calmly chewed on her rope (it appeared) as we approached by truck. The train-whistle-like horn of the truck not phasing her in the least, she finally shimmied sideways at the last minute, trotting over to the cactus-lined roadway as we drove on. Two little miniatures of her were already tucked into the cactus on the side but swivelled their heads also. Travelling around in Hinche is always entertaining. Usually by motorcycle (and occasionally by truck if we are at the mobile clinics), there can be up to three of us (and that’s tame compared to the live chickens, buckets of laundry or sometimes up to 5 people on other bikes), knapsacks hanging off the back, clutching each other and the driver as we careen around corners, honking the horn almost continuously (as everyone does here), through half-dried puddles and across the paving stones and dirt roads of the main town. The small children are fearless (and usually wave gleefully in their bright, primary-coloured blouses of their school uniforms), the goats are always in the way, the dust billows around you, the dogs are barking and getting under foot, the chickens scurry in and out, and you’re constantly watching out for everyone else driving the same! Lots of people walk, the occasional one bicycles, there are trucks and 4-wheel drive vehicles (the UN, world vision, etc), but mainly there are motorcycles, and they are the cheapest (and only) way to hire anything to carry you the relatively short distance from one end of Hinche to the other (takes about 20min by motorcycle and costs 25goudes, the equivalent of about 60 cents). I’ve actually been really enjoying the noisy ride back and forth from the hospital, though have been trying to get in at least 1 walk a day as well, to counterbalance the intense carbohydrate loading. The starchy staples of haitian food — yams, potatoes, fried plantain, manioc, millet, mais, even pasta —appear at every meal and I have been rejoicing at the sight of the occasional carrot-and-cabbage or beet salad, okra, bananas, and citrus. The protein we get is mostly pork (pigs in the gutters are a common sight) and, of course, goat. Brown mama, however, lived to see another day: I think it was fish tonight at dinner.