Paradox

Ti gran moun. A Haitian proverb used in multiple scenarios: when a child acts as if she were an adult, a toothless 1 year-old’s chewing looks like a 90 year old toothless woman, or a barely middle-aged man acts as if old age is starting to set in. Young old man.

A paradox.

A wedding week. An undeserved calamity met with such grace; one new delicate life boldly hangs on and another finally finds rest.

I gladly jumped out of bed after a nightmare filled sleep and awaiting first in line among the other fifty-some patients was 1.4kg, 3 week-old Alfondia. We had first met on her 4^th day in Haiti, my 300 and somthingth day.  As her grandmother allowed me a small peak at the tiny newborn, two things registered—her jaundiced skin and her disguised size under the heap of blankets. I sat in the early morning sunshine and removed the layers of clothing and blankets, letting the rays reach her face and upper shoulders. Now 3 weeks later, she was once again laying in my lap sleeping soundlessly and healthy looking despite the lack of hospital care we had recommended.  How could this tiny delicate being still be here? And then she smiled in her sleep and stretched her arms and long translucent fingers up-above her head… ti gran moun, I thought.

The same day, I heard about Blanco’s death. He had been a couple months old, and abandoned by his mother. Neighbors had taken him in, but he was sick and they had nothing to give. We encouraged them to return, as one day of IV fluids left him still shriveled looking with a sunken fontanel. He had yet to show much interest in eating and was consolable to finally rest while being tightly held in our arms. Was he held? Was he comforted? Was his last, and only 2nd month of life that of suffering?

Get your fill

Francois and Maumie:

Francois is a 70-some year old man whose presence never goes unnoticed. The first time he walked into our clinic, my eyes went from his black round bowl hat, down his royal blue button up, to the LoisVitton shoulder-bag that I couldn’t tell you was real or not. A second look quickly revealed his supra-pubic catheter tube exiting the zipper of his black pants, and entering none other than the Louis Vitton(sp?). And to this day, he enters the clinic in the same fashion. Every time, I think to myself: You can’t make this shit up.

  
Since his first visit, Francois has shown an array of personalities despite his lack of costume change. Some days he comes and is a patient, reminiscent man; on other days we discuss an odd time-line he pulls out of his Bible, or every photo in his wallet while trying to finish his physical. . I remember the Saturday he showed up to a closed clinic in December, and his mumbling  story confirmed what I thought I observed from the bulge in his black pants- his testicular hernia was bigger. I wish I were exaggerating when I told you that for 5 months now, he has been walking around with a testicular hernia the size of my head. His catheter was attached to a zip-lock bag, closed with a twist-tie; he was urinating from both the catheter and his penis.

Francois never leaves without putting his sunglasses on, if he ever took them off in the first place, giving us a blessing and tipping his hat.

Sitting in church this past Sunday was unbearable. Up until the past month, I’ve seemed to hold everything together relatively well. Relatively, because my definition of tame and under-control arises from my sometimes melodramatic and always chaotic, yet deeply-loving household. Perhaps it is because I am nearing the end of my year that each pair of round beautiful babies’ eyes seem more beautifully haunting, or the tinea capitus seems to multiply, and the unattended wounds are suddenly being left uncovered. The mother who comes weekly to campus, just begging anyone and everyone for food for her and her baby, for a number to see the doctor even though it’s 9 o’clock and all the numbers were handed out at 6 o’clock am. Patients were turned away, asked to come back tomorrow… how could I give her a card when others had arrived 3 hours earlier? She’s been told this. She spots me, smiles and waves. I left after thirty minutes of trying to hold back tears or a breakdown, as my eyes wander the crowd of thin Haitians, holding their babies and gyrating their hips with their eyes closed worshiping Jesus. And I feel helpless, frustrated… pissed frankly, and sad. At the same time there is a man sitting to our right asking, actually pathetically begging, for medicine because he fell and hit his leg the other day. There is an unrelenting need. I feel like I’ve had enough.

I see Maumie walk in late, clumsily looking for a place to sit. She is alone… two of her seven children survived, and she comes to church every Sunday alone. She walks from far, and doesn’t carry water with her. When she comes to the clinic, she is usually the last one to be seen because she doesn’t show up until the early afternoon. So while we close up I walk her out, where she walks to a spicket just about ankle high. She hikes up her dress, squats down and starts cupping water in her hands to drink. I’ve caught on to this routine, and if I walk with her to turn the water on for her she thanks me as if I’ve installed running water in her house or something. As she finds an empty space on the wooden bench in church, she begins clapping off-rhythm and joins in the worship. I know if I could see her face, her eyes would look big behind her glasses, and she’d be smiling.

Rose, Gabriel, Marie, Lukner:

Becoming increasingly familiar with the twists and turns, the makeshift fences or seldom a painted house which distinguish one route from another, house calls are becoming more frequent. Rarely is my first stop not to Rose’s house for a quick bottle of ensure and bath time, and then onto see patients.

As today proceeded seemingly normal, I took notice of the details that make it anything but routine. As I am triaging patients, it is brought to my attention that one patient outside is experiencing exceptional suffering, and maybe he should be let inside? I go outside to take a look. The skinny, scruffy man with a teal rosary hanging around his neck between the missing buttons of his shirt is using every muscle in his chest to breath at a rate of 35 respirations per minute. I think he merits a bed inside, and a breathing treatment. And I watch him working for each breath, wishing the albuterol would get to working already.

Gabriel has smoked his whole life, and his lung infection has acutely exacerbated his condition. His lungs encaged by ribs I can count one by one, and yet he has exceptional muscle definition. These few qualities tell me about a life I begin to imagine he has led; one of resilience, hard work, suffering. And yet he has manners, shows incomparable patience during suffering.

Another elderly gentleman, 75 years old, is led in by his wife, Marie. I recognize Marie, because she is a bold woman, proud of her family and always watching out for people in Chambrun. There is something about her that makes you glad you are on her good side, though I have never seen the repercussions of what its like to cross her. Her husband is experiencing stomach pain, “tranchman” or “colic,” and vomiting. His blood pressure is high, and yet he is clearly dehydrated because his leathery skin that seems to barely stretch to cover his slim abdomen, is tenting (when you pinch an inch, his skin stands much like a tent instead of rebounding back as your skin would do).

Both men are added to the afternoon list of house calls in Chambrun. Along with Lukner, an amputee who did not come for a follow up appointment last week, which would have allowed Aubree to give him the large tub of protein powder she picked up in the States. As I begin walking down the dusty road, I see Lukner’s wife on the back of a moto and yell to her that I’ll be visiting.

Passing by Rose’s house, I am immediately stunned. She is standing by herself. And she takes up to five steps at a time. A bath and bottle later, I leave her on her momma’s lap sitting on the foot of Gabriel’s bed, the first patient of the afternoon. I swear he could have just put out a cigarette before I came in, but his breathing is less labored, and he reports that the “pump” I have him helped him earlier when he started experiencing shortness of breath. He seemed pleased, and much more comfortable than this morning. So I gave him cefazolin shot and began walking to Lukner’s house. As I round a bend in the route, I surprise two woman stand staring at a donkey’s rear-end, and they nonchalantly smile and look up as I pass. After I can hear them asking if he’s constipated…

Lukner is laying on a tarp under the tree in his yard, with his baby grandson by his side asleep. He is in high spirits, and says he is planning on coming to the clinic tomorrow. The protein powder is a huge hit, and his wife is very pleased. She walks me to Marie’s house, as today will be my first visit.

We walk through the rusty tin-sheet front gate, and she picks up a rock. I notice the many dogs in the yard, and know she’s done this before…

I spot Marie, her uncovered large breasts both hanging over the fire in a small pot in which she seems to be burning rubber tire pieces… and her husband is laying on a mat, with two pillows under his head. She greets me and quickly tells me he has begun vomiting again. I ask if she has given him his meds… No, he hasn’t vomited since this morning when I gave him the last dose. So the teaching begins again. We go through all the medications, especially the antiemetics. She is confident, and I don’t know if it’s her nature, or if she truly processed the regimen.

I guess I know where he lives, and I’ll be back soon. So we’ll try again tomorrow if need be.

Heaven knows, sometimes I think it’s overwhelming but I don’t know if I could ever get my fill of this. Walking around in the dirt, delivering comfort and care to such loving people, pulling up IM injections inside mud huts with 15 people crowded in a tiny dark room watching, and always having a child’s hand to hold.

A selection from “Head Over Feet” by Alanis Morissette

You’ve already won me over in spite of me

And don’t be alarmed if I fall head over feet

Don’t be surprised if I love you for all that you are

I couldn’t help it

It’s all your fault

Your love is thick and it swallowed me whole

You’re so much braver than I gave you credit for

That’s not lip service

You’ve already won me over in spite of me

And don’t be alarmed if I fall head over feet

Don’t be surprised if I love you for all that you are

I couldn’t help it

It’s all your fault

You are the bearer of unconditional things

You held your breath and the door for me

Thanks for your patience

I’ve never felt this healthy before

I’ve never wanted something rational

I am aware now

You’ve already won me over in spite of me

And don’t be alarmed if I fall head over feet

Don’t be surprised if I love you for all that you are

I couldn’t help it

It’s all your fault

Mango Season

Fresh mangoes. Judging by the increased amount I’ve seen around Chambrun (stacked upon frisbees and balanced on childrens’ heads, being handed from one toddler to the next and then sucked down to the peel by their lonely two front teeth, and the couple bags I’ve received as gifts from friends or patients), I reason its Mango season.

The first bag-full was given to me by a toothless, perpetually confused patient, who was unable to pay for a consultation. I quickly stowed them in the back of the fridge, and forgot about them for a couple of days. Afraid they would go bad, Aubree and I decided to carry the bag of ten or so mangos to Chambrun to share among our normal posse of kids. After a quarter-mile walk in the midday sun with only a narrow margin of shaded road, we were quickly down to four mangos. We soon realized there was an exceptional quality to our mangoes, distinct from the many walking about on-top of kids heads over the past week. I had discreetly handed one to Franzy, an eleven-year-old from the children’s home, and before I knew it five more orphans were standing at my side, each given a respective mango. Their eyes boggled, as they looked up from their quiet giggles to explain…it was ‘glacee.’

Our mangos were cold.

The second bag was given to me by Macome’m Natacha, after I insisted on helping her re-mud their house. Each year as Good Friday approaches, the people in Chambrun get buckets of a mud prepared to patch up the house. Natacha’s has been standing for 10 years, tree branches cross-hatched beneath layers of mud. As I reached into the bucket for my first handful of mud, a dozen eyes or so were watching the ‘blan’ dig in. After a short few minutes, we were chatting and “masoning” the house as if we were part of the annual occurrence.

There are some days when we visit when I can feel the barrier between this group of friends I sit with several times a week. We close up the clinic and walk down the dusty road to visit, and are approached by many with their sick child in arm. We are not residents.

“Why didn’t you come to the clinic this morning? Or three days ago when your infant began having diarrhea?” I often wonder.

Its a part of this struggle I feel each time we visit-the struggle to break through the needs, the language barrier, the social divide, and emanate our essence of sameness, humanness, brokenness. With the kids, it’s never too difficult. All it takes is a bag of mangoes. But with the teenagers, the mothers, the women and men… its a delicate process of being invited, entering their homes, and more days than not because of the Haitians’ graciousness, we find ourselves breaking this extremely real yet unidentifiable barrier. Sometimes it’s a joke that we all find ourselves laughing at together; others is digging into a bucket of mud with our bare hands. Maybe I find this strange because so often in culture we are trying to figure out the “us” and the “them.” The “we” from “they”. The black from white. The guilty from the innocent. And on and on.

A loved one recently replied to one of my emails about mangos, saying:

“I think when you add a little salt into something sweet it really brings out the flavor. Maybe it is because you can contrast the two flavors simultaneously and appreciate each in light of the other. It’s like when I am having a ‘bad day at the office’ type of day and I get online and find a hauntingly beautiful photo of Baby Rose that you took. So mesmerizing. So intensely beautiful and tragic all at once. Like salt and mangoes. Good for some reason. . .

Little Rose joined us in church this morning, half head of hair in braids, a borrowed dress and a new pair of little gold hoop earrings. Her neighbors carried her in, and plopped her down on my lap. After church they asked if I could keep her for they day. After walking her home that night, I asked who leant her the earrings. The told me her mom had picked them out and brought them for her… the same mom who abandoned her, and seemingly did not want her. But how can you give love to a child, if you were never loved as one yourself?

Maybe this Mango season will be a season of change; to what degree I am unsure. But like others before it, I think it will be good for some reason…