Tippy Tap

This title may sound like some sort of drinking game concocted around a keg late one night, so I’m sorry to disappoint if that’s what drew you in. It is actually the name of an ingenious hand washing station for outside a latrine. This morning we built one in Do Digue.

Here’s what you need: 3 branches, some rope, a bar of soap, a gallon jug, some rocks and sand, a piece of rebar to pound out the hole, and of course a machete.

Raul, the owner of the house with this latrine was very effective at making the machete a multi-purpose tool. Mike did a respectable job for a “blan” (white person) and I stayed back and played with the kids.

Raul, the pro. 

Mike's respectable work.

The kids and I got off the bench towards the end to bring the rocks over and to add the soap. Then we all sang a song to remember when to wash our hands.

Lave me w ak savon, ak savon!

Lave me w ak savon, ak savon!

Avan w manje e apre nan twalet

Lave me w ak savon, ak savon!

Wash your hands with soap, with soap!

Wash your hands with soap, with soap!

Before you eat and after the toilet

Wash your hands with soap, with soap!

The finished product!

This is all part of the latrine project I talked about in my previous post. This Sunday we are having a community meeting to start collecting the families’ contributions to the latrines and to plan a building schedule. Once again I’ll ask, if you can, consider contributing to the cause.

To make a donation: http://www.indiegogo.com/projects/chi-composting-latrines-in-haiti?c=home

  

Everyone Poops

I would guess most have encountered the book “Everyone Poops” at some point in childhood or parenting. The book is helpful to some of us who are a little shy about this act. There’s nothing to worry about, Everyone Poops! The book explains that babies poop in diapers and everyone else goes in toilets. There is never a question of no toilets. Even the most stubborn toddler knows, if they need to go the bathroom and are willing to use a toilet, one is available.

Here in Haiti, that’s not the case. 

Do Digue is a rural village, with a population of about 600. It is also one of the villages Community Health Initiative (CHI) partners with. They have just one working latrine for the entire population and that was built last year. The only alternative is going on the ground. Besides the huge privacy and dignity issues, there is the large problem of sanitation. Open defecation puts the entire community at risk for diseases like cholera and rotavirus.   

The primary occupation in Do Digue is farming. Decades of embargos on trade lead a large portion of the population to turn to subsistence living, relying heavily on trees for charcoal production. This unchecked practice resulted in vast deforestation and erosion of essential top soil. Thus, today, crop yields are meager.

The people of Do Digue are sick of their children getting sick. They are sick of their children not having enough to eat. And CHI is sick of it with them. So now there’s a plan. Do Digue is planning to build thirty composting latrines, this year, with CHI’s support. The latrines have a large enough pit to collect a family’s business for one year. After a year, the latrine is moved to a new pit and the first is covered for one year. The year allows the waste to turn into compost the families can use as fertilizer. The goal, reduce diarrhea induced death and improve privacy, dignity, sanitation and crop yields with one project.

So here is where you can help out! Each latrine costs $250. So for 30 we need to raise $7500. Each family receiving a latrine is contributing $25. This is a huge investment for families that live off about $1 a day. This is how committed they are to change. The families will also contribute time and labor to the construction of their latrine. Another huge investment under the Haitian sun. If you can, please consider making a donation. If you can’t, please consider sharing this cause with some friends. Remember, your friends poop too.

To make a donation: http://www.indiegogo.com/projects/chi-composting-latrines-in-haiti?c=home

The one working latrine in Do Digue

The tippy tap, a handwashing station, outside the latrine

A small family farm in Do Digue 

My First Week, in Two Minutes

My first week in Haiti has flown by and I’m guessing the subsequent weeks will continue to pick up speed. The learning curve for the first week was large. It included, figuring out how to use a generator, solar panels and an inverter for electricity, learning how to fill a cistern to shower, becoming accustom to tap-taps and motos, adapting to being a walking spectacle by being “blan” (white) and determining the right cocktail of sunscreen and bug spray. The last one is still eluding me and thus the Benadryl stick has become my best friend. This list was just the learning curve for basic living. The learning curve for my project was equally as steep. 

A group like this usually joins me on journey, entertained by the blan.

An easier adjustment

No matter the amount of reading and preparation you do for a project, nothing compares to work on the ground. This week gave me the chance to meet with the supervisor of the water program here, the water program’s quality control workers, the newest CHI employee Alliance (who used to work directly for Gadyen Dlo, the water program we subcontract with) and my translator John. We were able to have several productive conversations and this information, combined with the results of the program evaluation survey I’m conducting will help direct the future of the program.

On Friday, I was finally ready to begin the survey process. I got 10 done in the day, which I thought was pretty good when account for the heat and the walking. This next week will be dominated by surveys. I enjoy this process because I get welcomed into people’s homes and thus far they have felt comfortable sharing numerous concerns with me. The other highlight to the survey process is that I get to spend the day with my hilarious and angelic translator John. He loves to say that the first time he looked in the mirror, he screamed at how ugly he was and told his mom she must have a dirty belly to make him. He will say anything self-deprecating, as long as it gets a laugh. Good company to have when you are hiking in 95° weather. I say his is angelic because he has adopted three children though he has very little monetary wealth. His dream is to open an orphanage and if his love for the kids of Haiti could build it, it would be open tomorrow. This past March, a crew of journalists came with the CHI quarterly clinic. One of the articles they wrote was on John, it can be found here: http://pulitzercenter.org/reporting/haiti-arcahaie-iowa-medical-birth-lifesaving-malnourished-medika-mamba.

Dana (another MPH student) and John, my translator, on our longest hike yet. We started on a road right by the ocean.

A brief history of Haiti

As I noticed in Romania, American high school history classes are great at avoiding topics in history that paint the U.S. in bad light. Yes, we talked about some of our unbecoming past; but, generally just things that were too big to avoid. Haiti’s history with the U.S., and France, and most of the developed world is not pleasant, and in the scope of their history too big to avoid; yet, I know it wasn’t part of my curriculum. To be able to practice public health or healthcare in a country it is of vital importance to understand the culture and history. So I thought I’d share with all of you the highlights.

In 1492, Columbus landed on the island of Hispaniola (present day Haiti and Dominican Republic). Within a few centuries of his arrival, the entire native Taino population died, mainly due to new pathogens. This was the first impact of globalization in Haiti. The demise of the native people, made colonization of Haiti a simple task, and in 1697 the French began ruling. The French turned Haiti into a slave colony for sugar production, mahogany exportation and as a source for American slaves. By the late 1700s, the slave population made up more than 85% of the island and an independence revolution began. In 1804, Haiti became the first independent black nation and the only slave colony to win its independence. This independence came at a high price however. The revolutionary war destroyed the colonial infrastructure. Additionally, most European nations, in addition to the United States, put trade embargos on Haiti destroying their ability to become economically independent. To make things even worse, the French being incredibly sore losers, made the Haitian government pay retributions for winning the war. The amount imposed, if done today, would be $21 billion. This debt payment took 80% of Haiti’s annual budget until the 1950s, leaving little money for development.

The twentieth century is when the United States really began influencing Haiti’s history. From 1915-1934, the U.S. Marines occupied Haiti as an attempt to secure U.S. sugar interests. Then the U.S. implemented an ineffective development plan, which was been attempted in many other countries with similar consequences. President Clinton, during a hearing of the Senate Foreign Relations committee, in 2011, explained it well,

“Since 1981, the United States has followed a policy, until the last year or so when we started rethinking it, that we rich countries that produce a lot of food should sell it to poor countries and relieve them of the burden of producing their own food, so, thank goodness, they can leap directly into the industrial era. It has not worked. It may have been good for some of my farmers in Arkansas, but it has not worked. It was a mistake. It was a mistake that I was party to. I am not pointing the finger at anybody. I did that. I have to live every day with the consequences of the lost capacity to produce a rice crop in Haiti.”

Finally, we get to the recent history that most people are familiar with: the devastating natural disasters of the last 5 years. Starting with four hurricanes devastating the island during a short period in 2008, culminating with the 7.0 magnitude earthquake on January 12, 2010 and most recently flooding due to Hurricane Sandy. These disasters have destroyed a lot of the infrastructure that did exist and have caused 2 million Haitians to be displaced.

The history of Haiti is fascinating. I don’t pretend to do it any justice here. It is intertwined in complex ways with many countries, is rooted in African tradition, filled with people who have family in the States or France, similar in climate to the rest of the Caribbean; but, entirely unique.     

Right next door....yet, a world away.

Yesterday morning, I boarded a short 1 hour and 15 minute flight from Miami to Port-au-Prince, Haiti. This is not much longer than the flight from Cedar Rapids to Chicago, but the change in the reality of the world, in these two remarkably close locations, is unbelievable.

Today, in Miami, the city that spends the most on healthcare per capita in the country, 3 out of 5 people will die in ICUs at the cost of about $10,000 a day. This morning, at breakfast, we were discussing the need for advance directives with a few of our Haitian co-workers. The idea of needing to direct when to end care and allow death to take its course is foreign, in a land, where 1 in 9 children die before the age of 5, most commonly due to a diarrheal disease.

Leaving healthcare behind, let’s move to the differences in life, I take for granted at home. Turning on the tap and getting safe water and always having a toilet to use that is connected to a safe sanitation system. If we let the sequestration affect clean water and sanitation for one day, I’m certain Congress could find a speedy solution to the federal budget. Here in Haiti, unfortunately there is no speedy solution to the water and sanitation problems. Prior to the earthquake in 2010, only 55% of Haitians had access to an improved drinking water source. Additionally, 49% had little to no access to any type of sanitation system. The combination of lacking sanitation and water infrastructure means ample water-borne diseases including rotavirus, E.coli, salmonella, shigela, campylobacter, and as of October 2010, cholera. To meet my water needs in this environment, about 3 liters per day, yesterday I brought two liters from Miami, bought one sealed safe bottle on the street and bought a gallon from a water truck. The water truck drives around like an ice cream truck, with music and all. They use a reverse filtration system and claim that the water is safe, though tests of truck water are frequently positive for fecal coliforms. So after buying the gallon, we treated it with the Gayden Dlo system to guarantee its safety. This is much more laborious than walking to the facet and complaining about the taste of water in Coralville. For people living on as little as $1 a day this isn’t just an inconvenience, it is a large expense.   

I can tell you two giant advantages to Haitian life, thus far, the gorgeous view off our balcony and fresh coconuts in our yard. I will be trying my hardest not to take these for granted like I do water and sanitation in the U.S.  

I'm back...and off to Haiti!

After about two years of silence, my blog is back! I left Romania with such good writing intentions. Unfortunately reflecting, in writing, on my final classroom year of medical school seemed boring, for lack of a better word. I thought I would spare you all. My classes this year, the course work for my Masters of Public Health, were very interesting and conducive to writing, and thus my professors asked for many papers, leaving little writing energy for blogging. I’m sorry, Grandpa. But, on Sunday, I leave for Haiti to complete my Public Health Practicum and I would love for everyone to come with me.

The Public Health Practicum is the chance for Masters students to take what they’ve learned in the classroom and apply it to a real public health situation. For my practicum, I will be evaluating an in-home water purification system called Gadyen Dlo, in Arcahaie, Haiti. I will be spending a little over a month in Haiti, and my time will be split between travelling to homes to perform water surveys and tests, contacting local schools to set up water educationals and researching other cost effective water purification systems, in use, in Haiti and other developing nations.

Haiti presents numerous public health challenges and numerous NGOs are there trying to address them. Unfortunately, lack of coordination between NGOs often exacerbates the problem. This is something I will be exploring through reading this summer and would love any thoughts people have in the comments below. The NGO I’m partnering with, Community Health Initiative (CHI), works exclusively in one area, Arcahaie. The founders realized that they could either do a little good over a large area of Haiti or could do a lot of good in one concentrated area. They choose the later, the approach I prefer in international aid. CHI has partnered with the community, since 2009, and empowers the community to identify the top priorities. Water quality was identified as a top priority recently, and in October 2012 the Gadyen Dlo program was implemented. 

I have much more to share about Haiti’s history and culture, about Gadyen Dlo and water quality and purification, about public health in theory and in practice, and about adventures in Haiti; but we have the next month for all of that. Right now, I will pause and go pack.