Resistance

Haiti’s Caves

Haiti's many caves, were spiritual centers for the Taino people.  Later they served as places of resistance for people fighting against the many oppressors in Hatien history.

When the Spanish arrived in what is now Haiti, the people who greeted them said, “Taino” This was the word for peace.  Christopher Columbus would go on to name the people the Taino’s.    The “Taino” were the indigenous people of present day Haiti, Dominican Republic and Puerto Rico.
 The Taino saw their beautiful islands as sacred, living things.   In a short time, disease, slavery and murder would reduce their numbers to near extinction.  An agricultural society with permanent villages, an ordered government and a great love for their spirits or zemis, were nearly destroyed. I like to say almost because I believe that the spirit and wisdom lives on in the mountains and the people.  Haiti is mostly composed of metamorphic rock; soft, coral Caribbean limestone made over millions of years from decaying sea animals.  This geological past created thousands of small caves, waterfalls and sinkholes.  These caves became spiritual retreats, burial places and the home to Haiti’s beautiful petroglyphs that offer us a window into the Taino’s magical past. 

Sacred water in Haiti

 They were places of resistance.   For the Taino and then for the Africans who escaped slavery and fought a revolution.  The caves served as places for the Taino and Africans to share their knowledge of survival and resistance.  Deep in the mountains and forests were the caves that hid the dedicated resisters of the world’s first successful slave rebellion.

These are in Spanish because the Dominican Republic and Puerto Rico were also home of the Taino.
How sweet is the baby?

But my favorite Haitien cave resister is Hinche’s local hero, Charlemagne Peralte who created a resistance to the US occupation in 1915.  An educated farmer, the US marines burned down his house and killed his brothers and put him in prison.  After his escape, he organized bands of resistance.   The US trapped him in a cave outside of Hinche but his bravery lives on. Eventually the US left Haiti but only after it further stripped the country of even more natural resources. 

 The Taino believe that human beings, after creation, emerged from Haiti’s caves.   They are places of fresh water, fertility and childbirth.
 These days, in my country, we look for ways to resist, even as we look for caves of comfort and support.   I am humbled by my country’s goodness, in the midst of a conquering enemy on our shores.  The people of my country, boycott, march, and use art and persuasion to resist.  They gather in prayer and song and dance.
 The Spanish came to Haiti for gold.  The French to make fortunes on sugar with slave labor.  The United States came to take natural resources and make it an economic colony. The elite of Haiti, created vast swaths of inequality leading to death and devastation.  In my own country people sacrifice the spirit of earth and community and constitution, for a hoped for wealth and superiority that can never bring lasting happiness.    The Republican Party, as it stands now, seeks to colonize its own country.
 Haiti offers me the image of the cave with its delightful drawings of what can be.  It offers me images of clean beautiful waterfalls as well as a people who knew the meaning of resistance.  I see them sitting by a small fire at the mouth of a cave with the water, clean and bright by the moonlight.  I hear their songs and their drums and smell the food of the forest.   I see women sneaking from plantations with news and supplies, risking everything for freedom.  I see Charlemagne who gave up his good life to resist.  I see his capture and his death and all it inspired.
 On the radio, they count the days of the new administration and all the things it does to attack and dismantle democracy.
But like Haiti, the drums, which is our freedom of press is not quiet.   We meet in churches and homes and meeting halls and walk the streets in a unified message.
 And sometimes we feel so broken, we must find the cave within us; that place that is so deeply connected to earth and water and spirit.
 I think of the ordinary day that the first people of Haiti stood on the shores and said “Taino” to the new guests to their island.   We are never fully prepared for cruelty and discrimination; for a worldview that believes some are intended to be master and some slave.
 We too, were unprepared and so we shrink and suffer and search for the place of resistance and strength within our selves and our families and our communities.   We all have people and places that offer us strength and one of those people are the Taino who greeted their enemies with “Peace”.
The Taino, who did not die but live on in the caves and waterfalls of a spirit that offers all people peace and abundance,
  

Trial in the Death of Oliver's Mother

There was a death but there is no trial, no coroner report, no peer review, no investigation, no law suit.


But in classrooms, across the United States, children are having mock trials of Christopher Columbus.  My grand daughters are in the midst of this study at their school.   They read Morning Girl about a Taino Indian girl and are now trying Christopher Columbus of the death of her people.

Christopher Columbus is greeted by the Taino Indians who he described as friendly and welcoming.  In less than 25 years, most were killed and others fled to the mountains and the outer islands.  

I say to my grand daughter, they are still dying.  It was not Espanola.  It was Ayiti; the word the Taino gave the land where Columbus landed and created his first settlement called LaNavidad.  

And so I accuse Christopher Columbus of the death of Oliver's mother.  I accuse him of creating "Colonality of Power"; a system in domination remains in continued notions of superiority.  I accuse him of taking an island free of gender discrimination and embedding it with attitudes that helped lead to Oliver's mothers death.  I accuse him of Hegemony; a system in which oppressive values an ideas permeate a society without being imposed.  

Christopher Columbus was taken back to Spain in 1500 where he stood trial for the genocide of the Taino people.
Today many people ask how Haiti is, without ever making a connection to long lasting effects of Columbus's legacy.

I accuse him of leaving an on going form of post colonial oppression that won't go away; that leads to a system where Oliver's mother was not able to make decisions to help herself and her children.  


Today I am going to talk to their class about the Taino in Haiti and the lasting legacy of Christopher Columbus.   I will tell them about the ways they escaped to the mountains and how they helped the slaves with their fight for freedom.  I will tell them about the beautiful ways the people love the land and care for one another.  I will tell them about the things that were taken but also of the things that could not be destroyed.

This story and others like it, make children really sad which is why I believe so strongly in service learning as a teaching methodology.  It allows the children to learn the truth about Christopher Columbus and his relationship to Haiti.  It allows them to understand that Haiti's challenges were created by colonialism and not just an earthquake.  But it also allows them to try to do some small things to help.    I'll make them a Santa list of things babies, like Oliver, might need in Cabestore. I'll tell them how hard it is to get to the market and how they might not have the most basic of things that could help a baby.

One day,  God willing ( as the Haitians say )  I will pack their gifts and make may way back to Canestore and offer them to the mothers there.   In this way, the circle of giving and receiving in cycles of healing and compassion.

And I will tell these children, over the holiday, when someone comes into your house.  Quickly offer them the best chair and sit with them and share a story.  Offer them whatever little you have.   Each time you do this, you honor the Taino's and the best of Haiti and show Christopher Columbus he did not win. There as something stronger than swords and it survived in the remote villages and hamlets of Haiti.

Recovery

I do not recover easily. It is two months and I still am overcome each day with joint pain and exhaustion.   They say it is harder on the elderly.  No one has much heard of it in Oregon and there is not much to do but tough it out.

I organize my day to cope.  The medical community does not offer much but I pick up ideas and try things.  In the living room is a water, foot soaking machine.  I put my feet in when it gets too bad.  My foster son suggests pressure socks which are a miracle for pain relief.  I design one pair for my hands.  I shower, put on ice packs and take a wide range of anti- inflamatory medicines and herbs.   I take naps but then must putter around to relieve the pain and keep my sanity.   I complete small tasks.  I have good days and hard days.

I study viruses for about an hour a day.  I draw diagrams and make illustrations.  I live in a summer sweet place with flowers and soft breezes.  In this place, I retreat and try to give my body space and time to get over the assault to its system.  I try accupuncture and lymphatic massage.  I try positive thinking.  I try despair.

I dream I am on the beach, waiting for a boat to LaGonave and something explodes and is on fire and then I realize it is me.  I am trying to get in the water and put the fire out. The people hold me back and say it is a ship but I struggle because i have to get in the water and put out the fire.

It is hard for me to think about Haiti.  I panic.  But soon Kenel is coming to start his internship and I have begun my study of Kreyol in my quiet afternoons.

I have gotten a small, black baby lamb.  When I thought I was dying I thought I'd like a field of clover with a baby lamb to watch graze.   I know from being a midwife that a big part of overcoming pain is filling your pallet with beauty and so I retreat and let the flowers and good things surround me.   I welcome visitors who sit beside me as I slip off.   Chikun- what?

On the pain chart I am still at focusing on the pain almost always but once in awhile I get it all right for a little while and I am somewhere else.  I had decided to learn global maternal health in the real world.  I prayed for understanding and wisdom.  Will this ever go away?  Will I be wiser or just weaker and beaten by the pain?

I try to focus on how fortunate I am to have the tools I have; to have food that is easy to prepare, water and a soft place to rest.  But when it climbs inside me and I cannot get it to calm down, I struggle with gratitude.  I sink. I do not what anyone to watch this struggle. I an animal who seeks that quiet place.  Sometimes I welcome distraction but it does not work well sometimes.  I try to laugh and keep a smile.  I pull weeds and try to keep my garden alive.

I try to think of others but pain is selfish.  People say I should not have gone there, anyway.  They hope I have learned a lesson.   Is there a lesson to a random mosquito, carrying a virus, landing on you?   I say the virus was around since 1950 making lots of people sick and unable to go to work.   I cannot explain how unfair it is that it is only getting recognition because its coming to the Americas.

There are other problems- a far worst virus breaking out in Africa, wars and children at our borders.   I clean much neglected cupboards.  Too tired to recycle, I build outdoor fires and drink tea while the little black lamb grazes at sunset and the white garden glows in the summer dusk.

The Plant Doctors

When we arrived, Monday morning, at the clinic, my symptoms were obvious to the women who daily heal friends and neighbors  with plants and water.  I could not stand straight and was already demonstrating the tell tale limp and bent posture for which it was named in Africa.  It means "bent person" and I was bent.

Children learn plant medicine by watching their grandmothers from an early age. Here they laugh as they prepare a bath for me.  

During the presentations and workshop I nearly passed out.   As soon as we were finished, the women, hurried me back to the cooking house and ordered me to take off my clothes.   A large pot of plants were waiting.  The little girls laughed and played.  How many times I had watched, as they prepared plant medicines, just steps from the clinics pharmacy.  These two worlds did not seem to meet.  I would ask the name of plants and press a leaf in my book and try to grasp what it was used for.   It was their main medical system.  They had no money for medicine but there were always the plants and their ancient wisdom. Inside, the doctors complained that there was no medicines anyway and everyone debated why there were no medicines and how to regulate them and if they were being stolen.  Outside they made their own medicines and distributed it to me with love.

Treatment for Chikungunya

Soon, I was being scrubbed, head to toe, with leaves.  The water and the brush of the plants offered some relief.   Their hands moved quickly and with skill.   They knew what had to be done.

The water and the plants and the rubbing all helped support my lymph system which was desperately trying to identify the virus, make cells to destroy it and eliminate it from my body.  With no formal education, they knew what to do.   Had I stayed, there would have been more baths but I left shortly after; bits of leaves clinging to my skin and woven into my dripping hair.

That night my body, taking advantage of my sleep, burned as it tried to further destroy the virus.   I tossed with wild dreams, sweat and chills until morning when I could try to go get a cup of tea and sit in the sun.

Many times, as my body ached, I would recall the bath on the mountainside of LaGonave.

Getting to know the mosquito

I try to get to know the mosquito who. long dead and decomposing, has caused  me and so many others  lives to be turned upside down.

She ( the female is the one who sucks your blood ) so I know she was a mother; a mother who needed to fill her abdomen with fresh blood in order to feed her young.

Here she is.  The mosquito that causes yellow fever, malaria, dengue and the virus I got; chikungunya. 

Her relatives, all 3500 species, cause 700,00 to a million deaths each year in mostly young children.
She is known as the anophiles mosquito.; aedes aegypti.  Mosquito means small fly in Spanish.

I think of her being born in the small cave across from the clinic; a hole with large rocks where garbage is thrown.  It is a perfect place to be laid and turn into a grown mosquito.  Her along with some 500 brothers and sisters floated there in an egg based raft.  There they could survive in dry times, waiting for the rains that would come and set them free.  There she hatched into a larvae and wiggled and wiggled changing her skin four times, swimming and diving before merging into a pupa stage for a quiet day of rest and fasting before emerging as a grown mosquito.  Did she rest there letting her body harden before making her way to a rock where she let her wings dry in the sun.  She would not live long but longer than the boys who hatched with her.  She had a few weeks but they only had a few days to mate and carry on the cycle.

There beside the limestone rocks she found her mate and began to grow her own young.  I could not have been her first tasty meal of blood.  She had to have sucked blood from someone else with chickungunya.  Others would suck blood from a person infected with malaria or dengue.   It was all being exchanged from person to mosquito all around us.  Her small wings flapped 500 times in a second.  This might have warned me but we were all talking and laughing.  It was afternoon but never mind.  She did not wait for evening as some mosquitoes.   Afternoon was fine.  She needed blood to complete the life cycle; her life purpose.

When she landed on me, she acted quickly, inserting her flexible mouth tube into my skin. It bent searching for a vein to get blood from and releasing the infected salavia into my system.  She neither filled her abdomen or lived to lay her eggs.  Swat.  A young child's hand reached out and smacked her, blood smeared on my leg and their hand.

Had she been sucessful, she could hve flown back to he edge of the same pool and laid her own eggs or waited a few more days for another blood meal.

Though she dies, the virus was busy finding cells to enter inside my body and beginning its task of reproduction.  For the next week if another mosquito bit me, I passed on the virus to the new mosquito who in turn gave it to another person. All over Haiti and the Caribbean this cycle was being duplicated in a rising epedemic.

My immune system, unaccustomed to the virus, had to create a way of attacking the problem.  As I continued to do trainings and prepare for the mobile clinics, a war was taking place in my body.  I had  come to do a very specific task and had created a schedule that I had hoped would result in the greatest benefit.  I had hoped it would set the stage to prevent death and disability in the mountains.

But I, like hundreds of thouands of people around the world would be stopped in my tracks by the same species of mosquito that caused yellow fever, malaria, dengue and now chickungunya.   Twenty four hours after the blood feast, I headed to town. The driver was sick; crazy sick.   We were all spreading it, from ignorance and poor diagnostic skill, passing the virus from one to another through the mosquito.

My personal mosquito was dead but the effect of her blood meal was gaining speed and power within me.

Chikungunya - The Bite

I am sitting on the steps outside the Bill Rice Clinic in LaGonave.   We had just had a great training with the matrones and community health workers.   Spirits were high and the children I had known so well, were gathered around me.  Kenel, from Henche was translating for me and was there too.  It felt perfect.   The children scream "Sarah" and swat a large mosquito who was biting my leg.  It is huge and stripped.  Blood goes everywhere.  It is not like any other mosquito I had ever seen before but I did not think about it.  We returned to our laughter and chatter.

Minutes before "the blood meal" they take pictures of the matrons and agent santes who attended the training. 

The good, good woman who helps me there comes over to us. She is walking with a stick and is all bent over.

"What happened?" I ask her, with concern.  She looks in so much pain.

"A mosquito."

I beg her not to help me.  I'll be fine I tell her but she shakes her head and smiles through the pain.  I remember that smile.  The smile that comes through the pain.  The need to be distracted and to keep moving so the body does not freeze.

Later we sit out back while everyone prepares for night.  Fires our built. Water is gathered.  Girls fix each others hair.   They try to fix mine.  Kenel is on the roof with the midwives; laughing and looking down at us.

I did not, could not know that the virus was beginning to take hold in my body.  The mosquito that bit me was dead but four days earlier she had bit someone else with chikungunya.  Its how it is passed from person to person.   It was first described in 1952 in Tanzania.  It made its way to the small mountain village of Haiti where I rested in days end.

As I laid down, under a veil of mosquito nets, the virus was invading healthy cells and reproducing.  Outside people were talking in the dark; telling stories and letting their laughter drift over my body.

Tomorrow we would work on the mobile clinic bags, create a pharmacy list and do Helping Babies Breathe with the whole staff.

Inside my body, my immune system was beginning to mount its defense against the invader.   I had several things working against me. I was older and had only nine months earlier had radiation for breast cancer.  My immune system had already taken a beating.

Chikungunya - This is the health department

Chikunguya


The voice is from the health department.  She has to talk to me because I am host to a battle between the virus, Chikungunya, and my own compromised immune system.  She is asking me when I went to Haiti, when I thought I was bit by the troubling mosquito, when I left.

Chikungunya was first identified in Africa and spread to Asia.  The CDC watches its spread to the Americas.

Did I leave the hotel in Florida?  Was I bit there?   They are afraid someone will bring it back and then a US mosquito will bite them and it will begin to spread as fast as it spread throughout the world.

"I only walked to the Denny's across the parking lot. I don't think I was bitten again but I can not be sure." I am no longer sure of anything.

I tell her I need to look at a calendar.  I can not think about time.   I learn to live in the present; dealing with the constant pain I have felt since chikungunya entered my body.   Has it been weeks? Months? Days?   I only can think of what I can try to stop the pain.  I use ice bags, buy supplements, rest, drink fresh juices, take pain medicines but it is always, always there.  I try anything and everything but a disease which has crippled millions of people is mostly unheard of here.  I am the only case in Oregon.  My doctor looked it up on the internet before seeing me.  The main concern was reporting it to the CDC.   "There is no cure."  she tells me but I knew that.

I try to answer her questions.  I cannot focus but then she tells me she worked in Haiti for a year and we turn our conversation to Haiti.   If I am in pain, what are the people there doing?  Will few volunteers arrive with the much needed pain  killers?   I take warm showers, ice my feet, wrap body parts in pain strips and drink clean water.  I have tylenol and mobic.  I can watch the whole 9th season of Greys Anatomy.

But I am trying to answer her questions. "Why did I go to Haiti?  Where was I ?   What was I doing?  When did I first notice I was sick?  What did I do?  Were other people sick?'  

I try to think and then the nightmares of memory return.   Everyday I look it up on the internet.  I search for the experiences of other people.  I look for reassurance and understanding.  

Since I was a child, I used writing to my life in order; to relieve the pain and confusion and to look for hope.   This is my story of global maternal health.  It has many chapters and this is one of them.

I can see the look in people's eyes or they come right out and say it.  "You shouldn't have been there in the first place.  We told you Haiti is not safe and now look at you."

I walk with a limp. I feel crippled.  I hope it will pass but I do not know.  I look at people on bicycles with wonder.  I once rode a bike. I once hiked in the forest.  I had walked up the mountainsides of Haiti.  Did I understand my risks?   Would I have gone anyway?

Here is my story in installments.

"My Mom has died. " Melove in Haiti

In loving memory of Melove's grandmother who loved her family and cared for them though many joys and hard times.  In this photo she is making castor oil from the beans Melove picked.  She sold them in front of the house she shared with Melove and her children.  She had polio as a child and could not walk. I did not know  she had diabetes which led to the amputation of her feet at Justinian.  Despite this drastic measure, she died this week, leaving an empty place on the road to Bois-Camain.  She always welcomed me and any other guests, pulling up a small.market chair for us to sit on.  She was a Seventh Day Adventist and loved her church.  Despite the rocky road, someone would push her to church each Saturday for services.   A warm and welcoming person, I will miss her when I again walk that way and I am so sorry for Me love and her children who depended on her kindness and love for their very survival.  Brave, courageous and gracious, we celebrate the courage and faith in which she lived her life.   She lived through many political changes, natural disasters and personal tragedies.   May the beauty of Haiti wrap he rin their arms and offer peace and comfort.  

The teenagers walk to school

It is late Sunday afternoon and I am being picked up to go stay in the guesthouse of the hospital.  I have agreed to do the Helping Babies Breathe training for the nursing staff there.  I sit outside the clinic with various people of the village.  The clinic yard is the town square.  This, the soccer field and the pump are where we gather.

Gathering at the soccer field in the evenings.    There is no high school in the villages so the teenagers must walk down out of the mountains each Sunday and back again on Friday.   Families work to help one child get through high school.  it is not free here and there are books and uniforms and board in town.  If your parents have died there is little chance you will be able to go.

A man has fallen off his donkey and has smashed his leg.  It is twisted and turned and not looking good at all.  Who knows how long it took him to get this far.  I am picked up in the ambulance but the driver does not want to put him in.  Everyone crowds around and insists so in he goes with his frightened daughter and some crutches. Two teenagers climb in as well.

I do not think too much of this at first.  But them it becomes clear. There are  many teenagers  walking down out of the mountain to go to high school in town.  They are walking miles and miles on rocky, mountain roads that are little more than paths.  We fill the ambulance to overflowing but there are many, many more.  They emerge from scrub brush and rock and burning charcoal.  They gather at the last pump and walk past soccer games on dusty crossroads and grandparents making thread from rice bags.  They leave whatever family is left and whatever family survived to make this walk every week for their future, for their families, for Haiti.  They wear back packs with freshly washed uniforms.   They will stay with a relative, a friend, a person who needs help with cooking and cleaning.   They wave to the farmer coming home with his machete and their sisters getting water.  They are the best and the brightest their villages, their families have to offer.  It is for them they cut the trees and make charcoal. It is for them there is never enough food.   It is so they can have the education their parents never had.  It is not free.  Their parents and they must work and then they must walk home each Friday; up the mountainside where they must help their family and study before walking back down.

We  turn a corner and the sea, cool and blue like a postcard calls to us but no one answers.  They are going to school; going to school in the hope that by the time they finish, they can get into college or get a job and help their families.  I watch this brave, beautiful march down the mountain.

I watch this knowing, that in the village I come from, nearly half the teenagers will choose to leave high school; to drop out, to take another path.  Their education is free, the books are free and they do not have to wear a uniform.  They can live at home and are given free food, if they need it.  They are given a ride or a car or a bus ticket.  They have sidewalks, electricity and running water.   But they have lost the journey, are starved for the journey, for meaning and navigation and the belief that the world will be a better place for their effort.

I want an easy way down the mountain for these kids so much I could cry. In my heart, I am cheering like I am at a soccer match.  You can do it.  Don't give up.   And world, please don't give up on Haiti either.  At the end of this walk, they need jobs, higher education and the promise of possibility.  Please make this walk worth making.  

And if you are a teenager in my country, you are a part of the walk too.  I know it is hard to see.  Even with lights and cars and a free education, we have made the road almost impassable for you.  In the name of commercialism, we have denied you the journey.  I am not sure, by the end, what is breaking my heart more.

As we come into town, it is dark.  We drop our students off and they melt into a path, into night fires and dirt streets.  There are many still on the road behind us.  We drop the man withe the smashed leg off and I go to the hospital.

Next Friday they will be back home again.

Gratis - the cost of healthy mothers and babies

Gratis

The cost of healthy mothers and babies

 

Prenatal classes for all the pregnant women who visit the clinic.  The posters are made on from materials I buy at Scrap in Portland, Oregon.  After I did it once, the midwives took over

Ever since I have suggested that the prenatal care cannot cost anything, I have head the word “ gratis” passed around in animated voices of disbelief.   The social doctor is vehemently against it.  He says free health care will ruin Haiti and no one will pay him.

I look around the clinic.  Five paying patients a day is not going to support even one of them, yet alone the whole staff.  They are not earning their keep, even with their payment system.   It is not financially viable.   There is a chart person, a lab tech, a pharmacist, two nurses, two doctors, and now two midwives.  There are all sorts of housekeeping and grounds people.   Outside the clinic there are hundreds of women with no prenatal care.   He shrugs.

“How much is a visit,” I ask. 

“About $1 US. “

“How much are they earning?”

“Maybe $4 a week.”

“So ¼ of their total weekly income must go to this visit and this does not count lab work and pharmacy and the four hours to walk to and from the clinic.

“How much to have your baby, in town, at a hospital?’

“It starts at $50 US dollars but you pay more for medicine.”

“Two months of their yearly income. “

“Is family planning free?” 

“Nothing should be free in Haiti.”

“Healthcare is free all over the world.”

“Not in Haiti.  I need to be paid.”

“You are being paid and you got a free education.”

“I need more.”

The debate, over health care, rages in my country as well.  However, even the most conservative politician, understands that prenatal care for all women is a sound social and economic investment in the long -term well being of a community.

 The countries with the best maternal and newborn outcomes provide medical, social and economic support to the newest members of their society.  The yet to be born are nourished, given medical care, and once born given time to be breast fed and provided with a free education.   Mothers are offered an opportunity to choose when and if they will have more children.   Many give mothers paid time off in the last weeks of pregnancy and ample time to care for their newborn before returning to work.  

One of the new midwives providing care

doctors in Haiti and many part of Europe, complete a social year as a gift to their community for a free education.  The social year doctor is pretty much against free care, prenatal care and midwives.

“There are very few pregnant women in this area.”

“But there are so many children.” I reply.

“Well, even if there are pregnant women, they don’t like prenatal care.”  He explains.   “Haitien women do not like prenatal care.”

I had seen women walk miles for prenatal care in other parts of Haiti.  I am confused and the midwives were hired, I thought, to meet an identified need.

“Have they ever had it?”

“No.”

I always consider the possibility that I am wrong and wrong in another person’s country is even worst.  I walk around on the roof and consider.   If no one comes because it costs, then why have the new midwives?   Is health care a human right or something only a few can purchase?  For my own country, I want health care for all. It is what I want for all women, everywhere.   I toss my cards with every pregnant women needs free health care. 

The young doctor, who is also the clinic director, was born and raised in these mountains.  I am at the clinic for over a week before I see him.  When I do, he smiles and quickly agrees to free prenatal care.  Within two weeks, there are pregnant women sitting on benches, waiting for care.   The new midwives are smiling and doing the work they were trained to do.  I breathe deeply and smile.

Through walking, I learn

Through walking, I learn

A mother and her twin babies I met on my first walk in the villages surrounding the clinic.  There were many pregnant mothers and babies who had never had prenatal care and were happy to hear of the two new midwives from their community.

I have come here to help an organization with the set up of a comprehensive maternal health program in rural Haiti.   Like many clinics, it is contained within high cement walls with an iron gate. There is always a local man who watches over things and that is true here as well.  He has been here for as long as anyone remembers and his sons live here, as well.    

On Saturday morning, I walk with two sons, to the nearby school and church.  I ask where the nearest water pump is and they offer to take me there.  As I am scrambling up hillsides, barely passable on foot, I am thinking of one WHO requirement for a safe birth- “access to a skilled birth attendant.” 

I have grown somewhat accustomed to motos but this does not seem passable even on a moto.  Only one moto passes us  and we never see a car or truck.  I had asked to walk to the nearest pump.  I had not understood how far and how difficult the walk would be.   I walk and walk but still we have not come to the pump.  I can not imagine that they met the second WHO requirement for safe birth “access to transportation in an emergency.”  Even if they could get down off the mountain, the clinic ambulance is kept in town and so it would take an hour and a half, for transport after walking to the clinic.   Women in shock or seizing can not very easily be propped onto a motorscooter and bounced over rocks. 

“Just a little further.”  My new friends know everyone by name and we stop to say hello at every house and sit on stools in the yard as we visit.

We pass small houses with tin roofs that are mostly isolated and not clustered.   There are small, harvested patches of Congo Beans that appear as sticks bare of any currently growing leaves.  They tell me they will replant when the rain begins in a few weeks.  Some houses are blue plywood and show that perhaps a volunteer crew had built them.  Some have outhouses and the earth houses have the added benefit of the rocks for building material.   There are very few animals; a very occasional goat and one cow pen but without the cow.   Most of the historic mangoes were cut for charcoal.  We see a young boy busy with a machete cutting down the only tree in his yard.  

In some places, in Haiti, there are rivers for washing clothes and other household chores.  Here, there is no fresh water at all anywhere that I have seen.  I can see that they do not meet the United Nations suggestion that all people live within an hour walk of a water pump.   This is at least one hour up hill, over rocks and boulders. There are no smaller stores and the main ferry town is an hour the other direction from the clinic.

We pass babies in every yard; mothers, babies and children of all ages.   I wonder how anyone came to live up here, far from the sea and fertile land.  There are caves everywhere; large, craggy caves.  I think, a runaway slave or Taino Indian would have made their way up here rather than being a slave or killed.  Perhaps these strong people are the survivors of Haiti’s genocide; tucked in caves and rocky hillsides making a life for themselves away from mainland Haiti.    

When we get to the village I can see the skeleton of a market but it is Saturday and almost nothing is for sale.  Market day is Wednesday. There is a well made chicken fighting ring, a small Catholic church, a school and a rice mill.  There is a World Vision compound but no one is there.  “They left Haiti” I am told. There are young men, children and a red, clay clearing, which is the town center.  There is a clinic building but no one to run it.  There are no other buildings and most of the small houses are on the outskirts of this village. 

We see a young woman in early labor who slept at the clinic the night before but when she did not have have her baby, returned home.   I consider that there should be a clinic up here every week as well as a small, rural birth center.    Without transport this area is remote, isolated and a dangerous walk to town for a pregnant woman.   She tells me she is far more afraid of the moto ride at night than birth with a familiar and loved matron at home.  She has considered her odds for living and decided home, without any life saving medicine, is safer than the road.

On the way back down, we stop at a “girl friends” home and there is an older woman with a flock of children.  One toddler is on the verge of dying.  I know the signs; the sores, the drooping, wet eyes and lack of any sign of life.  She picks him up out of the dirt and holds him. Another child drops his plain white rice in the dirt and gobbles it up; sure that there is no replacement and that he might have to soon fight off the one turkey.   I ask about MedikaMamba; a program for malnourished children but no one seems to know.  I tell her to bring him to the clinic on Monday but she says she has no shoes to get there.   No one is wearing shoes but I am unable to continue without mine.  I got them for $4 at Goodwill and someone may have them when I leave but sadly not till then.

One in four children, under the age of five will die in Haiti.   I tell the community health agent to go see him and tell her again to come down but I don’t know.   Everyone is running around. His mother has left him with her and he seems mostly forgotten amongst the dirt and rocks.  He is not fighting for rice.  He has given up. 

We make faster progress on the way down the mountain and when I arrive back, I lie down.  I shut my eyes and review the barriers for women and babies, I noticed on the walk:

1.     An inability to get to the clinic for prenatal care or delivery and post partum.

2.     Even a nominal charge may be prohibitive.

3.     A lack of water and food. A lack of topsoil for gardens and farms.

4.     Children spaced too closely together may mean they are not accessing family planning. 

5.     Perhaps a lack of men remaining with the family.

6.     Women leaving children to go work in the city; a lack of jobs.

7.     Communication about the services of the clinic reaching those who need it.

8.     The continued cycle of poor soil, lack of clean water and poor roads caused by the cutting of trees for firewood.

When the solar power goes on, I plug in my kindle, camera and computer deciding the kindle and a book to read was most vital.   I cannot bare not to have something to read. I am in a country with no books and where only 10% of the women can read.   I have just finished Claire of the Sea by Edwidge Danticut.   She always helps me to see.  She helps me to see the song in what I see; to hear the children playing and the women singing.  She helps me to notice the blue sea and the one old mango tree that has been saved.  

It grows dark and someone brings me a mosquito net and hangs it in my room.  They bring me a coke and some ice.  I cannot tell from where these gifts are coming but I accept them with gratitude.   It is getting dark and the solar power has stopped working.   Everyone stays outside as long as they can; talking, joking and maybe singing.   Tomorrow is Sunday and it is a day to shine.

I can help set up a prenatal clinic but there is more; there s trying to understand what the women need to be healthy over the long run.  There is the trying to understand why there is not already prenatal care and if the lack of it impacts lives, in ways no one has identified.   What are the stories that impact health care and what can I learn as I set out for a walk or sit by the road, beyond the clinic gates?