The latest happenings

These CHE trainers are tying up buckets to be able to transport them back to their villages. We received a large donation of buckets, scrub brushes, and hand soap from IOM to distribute at oral rehydration posts.

Someone very close to me asked me tonight what I'm doing these days at work (thanks, Mom!). It turns out I've never mentioned that I'm no longer helping coordinate volunteers coming to work with cholera patients. Thankfully, the worst part of the crisis seems to be over. So, while we will continue to maintain oral rehydration posts in rural areas for the foreseeable future (so that people won't die of dehydration on their way to cholera treatment centers), we're mostly back to our former work of training in disease prevention, spiritual discipleship, and development.

I am still involved in trip planning:

• A group from southern Haiti will be coming to see some of our CHE villages in the northeast in April, as they consider whether to be trained to use the CHE tools themselves. I'm really looking forward to this trip since I haven't been to this area before and it's where some of our strongest programs are.

• Marcelo Lopez, an Argentine accountant and economics professor, will be coming in May to give a microenterprise training to our trainers. He comes once or twice a year with different materials. I've been coordinating his trip in part because I'll be his interpreter while he's here.

• A church in Detroit will be sending teams to make badges for our trainers, committee members, and community health evangelists. We are so excited about this! Almost everyone who works with us is a volunteer and doesn't receive renumeration. A badge is something they've been asking for for a really long time.

Speaking of “encouragements” for our volunteers: we've ordered t-shirts! Over five hundred volunteers have been working so tirelessly for months with the cholera epidemic, and before that they were teaching their neighbors about physical, spiritual, and emotional health in their spare time. We received funds a few months ago to buy everyone a “Medical Ambassadors Haiti” t-shirt! So, one of my jobs was to aid communication between my Haitian and Dominican colleagues during the ordering process (they don't make t-shirts here). And the upside is, I learned how to say “polo shirt” in Kreyol and Dominican Spanish. (It's actually not that exciting, it's essentially “with collar” in both languages.)

Nurse Marie Junie and my colleague Osse stand by a rented truck ready (as soon as the tarp's put on) to take donated cholera supplies to a hospital in the west. In addition to buckets, soap, and brushes, IOM also donated this hospital several boxes of IV solution and sprayers. A big shout out to Marie Junie: she left her house before 5 am to get to our office, and then had car trouble returning over the mountains and didn't get to the hospital until 5:30 pm.

Cholera Treatment Center photos

In December I had the opportunity to work a few more nights in a cholera treatment center in Haut Limbe (see previous posting). Above is 15-year-old Juan. He was very ill, and you can see that he has two IVs running. But when one of the volunteers was making balloons for the kids, he was well enough to ask for a cat to be drawn on his!

Here I am at 5 am with a volunteer named Travis, a fabulous ICU/ED nurse. The first night we worked together he put in an IV in the scalp of a little girl for whom they just hadn't been able to keep IVs going the day before. Scalp veins are really tiny, so only small amounts of fluid can pass through them, and this girl was very sick. So he and I stayed at the bedside to push fluids via syringe into the catheter. While we were doing this dawn broke, and the family members throughout the center started a worship service from the bedside. They sang hymns, recited psalms, and prayed out loud. What a beautiful accompaniment to our work, to be reminding of the One who is always working in and through and around us to bring healing!

Rehydration is the key to curing cholera. Here a girl is receiving oral rehydration solution from a family member in addition to her IV fluids.

This picture was taken the day this boy arrived. I met him the next day, and although he was still quite sick he was sitting up at the end of his bed drinking oral rehydration solution from a pop bottle, a little cutie-pie.

Cholera Carols

I am staying for a few nights near Limbe (an hour-ish from Cap Haitien). Last night I worked at the cholera treatment unit here. Today my coordinator and I met with Doctors without Borders to discuss possibilities for collaboration in Bayeux a village an hour from here. I also facilitated communication between my Haitian and Dominican colleagues to get a shipment of cholera supplies on Sunday, communicated with future volunteers about airport closures and flight cancellations due to the roadblocks and demonstrations that started today. And then, when I thought that after supper remained only sleep (after getting 2 hours in the past 36), I found out that we would be gathering with some of the volunteers that have come to work with the cholera patients.

It was lovely. We sang Christmas carols, read the story of Jesus' love for Mary and Martha and his weeping with them in their sorrow just before the resurrection of Lazarus. We heard from a sermon that addressed why Jesus weeps and where he is in moments of death and suffering. As we sang the carols, we kept on finding ones that were about cholera. I'm not kidding! Now, maybe if you haven't been working many dark, tiring nights battling death and dehydration, you won't see the songs in the same way. But here are a few verses:

O Come, O Come Emmanuel

O come, thou Dayspring, come and cheer

Our spirits by thine advent here;

disperse the gloomy clouds of night,

And death's dark shadows put to flight.

Joy to the World

No more let sins and sorrows grow

Nor thorns infest the ground.

He comes to make his blessings flow

Far as the curse is found.

(Cholera would be the "thorns" that are literally infesting the ground and seeping into the drinking water.)

Okay, there were more but my brain is no longer functioning. Good night!

Cholera Update

Hi, everyone! Our internet has been nearly non-existent recently, and when we've had it it's been slower than the slowest dial-up you can remember. But suddenly today it is running beautifully! Um, when we've had electricity, that is—I think it's gone off five times today.

Thank you all so much for your prayers for little Odlin. I stayed in touch with one of the nurses from Hinche by phone, and I'm happy to say that he continued to slowly get healthier and finally went home! When I think of what he looked like the day he came in, and indeed even the next few days, I am just amazed.

Every day there are more patients in more communities sick with cholera. There is no sign of this stopping for the next few months, if not longer. There is also a lot of misunderstanding about cholera. It's not uncommon to hear people say they would rather get HIV than cholera. In the past weeks our work has been to:

• Coordinate shipments of IV solution and other supplies to combat cholera.
• Prepare for a Training of Trainers in Port-au-Prince, specifically designed for people who have children's ministries. We were supposed to go to Port-au-Prince on Sunday, but have postponed the training due to continued violence in the city.
• Follow up with the Community Health Evangelists (CHEs) who continue to teach their neighbors from house to house. I've mentioned before the lessons they teach for physical health: what is cholera and how is it spread, how to wash their hands with a simple system using a plastic jug, string, and a stick (most people don't have running water), how to make oral rehydration solution at home, and the importance of using latrines.
• The CHEs have also helped people develop frameworks to process things emotionally and spiritually. Cholera is yet another disaster being faced this year, by people who suffered greatly from the January earthquake and now also violence surrounding national elections. I have heard many people, even young children, say that Haiti is cursed, and cursed by God. What a terrible burden to live under! Our lesson entitled "God and Cholera" leads people to God's Word to learn about God's character and God's heart for us.

On the last day of the feast, the great day, Jesus stood up and cried out, "If anyone thirsts, let him come to me and drink. Whoever believes in me, as the Scripture has said, “Out of his heart will flow rivers of living water." Jesus (recorded in John 7: 37 -38)

And when Jesus speaks in Kreyol, you hear it like this: Dènye jou fèt la, se li ki te pi enpòtan. Jou sa a, Jezi kanpe devan foul moun yo, li di yo byen fò: Si yon moun swaf dlo, li mèt vin jwenn mwen, li mèt vin bwè. Moun ki mete konfyans yo nan mwen, y'ap wè gwo kouran dlo k'ap bay lavi koule soti nan kè yo, jan sa ekri nan Liv la.

Cholera in the North

Evelyne, me, Solencia, and Mme Grimard (some of my colleagues)

From a note I wrote to my coordinator on Wednesday, November 17 :

Last night I went to the Cap Haitien gymnasium where I was given a tour of the cholera treatment center by the director for Doctors without Borders (MSF) for northern Haiti. MSF has been here for a week and are now seeing only a quarter of the deaths in Cap Haitien compared to the previous week. So much of this has to do with the importance of understanding how easily treatable this disease is, if only patients are hydrated quickly! The MSF director told me that the hospital wasn’t quite where they would like it yet, but they were pleased with the improvements. From my perspective it is so much better than the nightmare I lived through in Hinche.

As soon as the roadblocks clear they will be bringing tents to set up outside the gym to enable them to expand to over 400 cholera beds. They are now coordinating all cholera treatment in Cap Haitien, although they do work with the health ministry. They have also been working in Limbe, the other area where we would like to send volunteers. They only knew about the two hospitals there, not the 60-bed (and rising) center at Seminaire Limbe, five km from Limbe. That is where Dr. Steve has been working tirelessly and with few staff. MSF plans to return to Limbe (again, as soon as the roadblocks clear). They are coming back to the hotel now so I’m going to see how soon they think they can get through. Dr. Steve only has enough IV fluid for the next 24 hours.

Since we don’t usually work with short-term medical volunteers, I’m glad that MSF has accepted to take them under their wing here on the ground – we will just need to coordinate flights, airport pickups, meals, and housing, which will be part of my job the next few weeks.
MSF has also offered to train our community health workers on “bucket chlorine.” This means that a person will be stationed at each community water source (if there are too many some will be closed). The worker will have a concentrated chlorine solution and will put a specified amount in each bucket of water collected. In other countries this has reduced the cholera outbreaks to two or three days. However, due to the already widespread nature of Haiti’s epidemic (now in every region of the country) we will likely need people to do this work for a month or two.

Brief return to Port-au-Prince

Cholera Treatment Center tents in Hinche

Saturday, November 13:
I arrived in Port-au-Prince yesterday after spending the last seven days and nights working in Hinche with patients who had cholera. This morning the J/P HRO group loaned me a computer so I have been able to catch up on some of your responses. Thank you so much for your prayers and notes of encouragement!

It can be so challenging be aware of God's presence when one is physically, emotionally, and mentally exhausted. I thank God for your prayers, and praise God that in the last few days I was really able to gain a better perspective in the midst of the horror. Too tired to focus in prayer, I listened to a song with the following lyrics, "I will lift my eyes to the maker of the mountains I can't climb...'cause you are and you were and you will be forever...you fashioned the earth and you hold it together." How true! God is always moving everywhere to bring life and healing and hope.

Thank you for your prayers for Odlin. He was not on his cot when I arrived to the tent hospital the following day, and everyone assumed that he was dead. What joy to find out the next day that he had been transferred to the neighboring "real" hospital and that they were treating him for typhoid fever. We had already been giving him the antibiotics that treat that terrible disease. I was able to visit him yesterday and he looked somewhat better, although he is very weak and still has diarrhea. There was no family by his side, although I heard that his mother had been around some days earlier. Please continue your prayers that he would not be alone, that he would be assured of God's presence and that he would be completely healed.

Before leaving tonight for my "home" in Cap Haitien I will be visiting the site where we will be holding a Community Health Evangelism (CHE) training in December here in Port-au-Prince and working out logistics.. My computer is still not working due to viruses, but my brother-in-law has sent several CDs and SD cards of material to help it to work again and then to de-bug it and our office computers. Until I get his package and, Lord willing, am able to resurrect my
computer, I may not have much access to the internet.

I will be in Limbe all next week, a town 20 km (one hour and a half) from Cap Haitien. Our team will be training people to be trainers in new villages using the holistic CHE tools. Our volunteer trainers continue to go to village after village teaching cholera prevention. Cholera is spreading quickly in Limbe and in Cap Haitien and many other places in northern Haiti. There are not enough supplies or medical personnel. We have one more shipment of supplies arriving
from the Dominican Republic tomorrow. For the next few weeks I will be facilitating communication between those who want to come short-term (particularly nurses) and the areas of need. I also hope to be able to help get experienced groups such as Doctors without
Borders to the remote areas we work in.

In the name of the one who has defeated death and the grave,
Liz

Arrival in Port-au-Prince

Breaking down the tents at the J/P HRO refugee camp hospital. (All pictures from J/P.)

I arrived back "home" in Cap Haitien on November 13. It's now been over a month since my computer and all of its drives were disabled due to viruses. That problem combined with inconstant electricity and internet access has interrupted my blogging. I will post here some e-mails that I sent during that time.

Wednesday, November 3
Hello! As many of you have heard, there is a tropical storm/hurricane approaching Haiti. It looks like the rain should start at about 1 pm tomorrow followed by hurricane weather on Thursday evening or else on Friday morning.

I'm still in Port-au-Prince working with the J/P HRO. The plan here is to continue dismantling the tent hospital and store everything by tomorrow noon. We will attend emergencies and deliveries only. As soon as the rain starts, we'll come back to our base which is a large
house. We have stored all the tents we were sleeping in (on the grounds), and we'll start sleeping inside tonight. As soon as the rough weather stops (on the sixth?) we will go back to the refugee
camp and set up to start attending patients as quickly as possible.

In the morning I was the "designated doc at the camp for emergencies." I only saw a few pregnant women, but the title sounds good. In the afternoon I perfected my taping skills at the house we were staying at!

This is a very well-organized group, and I am privileged to be a part of it. Please pray for the people in the refugee camp. Evacuation routes are still being planned, and they are worried about landslides. Please continue to pray for our Community Health Evangelism (CHE)
teams up north. I heard today that the cholera cases continue to increase in Cap Haitien and Limbe. We praise God that yet another shipment of IV solution, chlorine, and oral rehydration salts were able to come in from the Dominican Republic, albeit with some
difficulty crossing the border.

We are anticipating not having power soon, so I will probably not be communicating via e-mail until well after the storm is over. We are anticipating a lot of injuries in the camp due to the weather conditions, and so we wil likely be very busy for days.

After my night shift was over this morning, I attended the meeting of the (mostly Haitian) medical staff. As their portion of the meeting started they sang "Count Your Blessings," then one woman prayed, followed by all reciting Psalm 23. May God truly shepherd this land
and the people He loves so much.