Thursday, March 21, 2013

A Coordinated Effort

These past two weeks have been more than busy for me and my team. We just finished with our midline data collection! In other words, we just measured, weighed, conducted BIA and hemoglobin tests for 1167 kids. Oh yea, and we did it in nine days. It may not sound like much of a feat but let me explain the events leading up to these whirlwind weeks.

Midline was originally scheduled for two weeks; the 11th through the 22nd. Then we found out from the schools that Easter break was actually starting March 15th, moving everything up a week. No problem, we thought. It’s still two weeks and it’ll give us plenty of time. Then we realized—the kids don’t go to school all day. The Haitian school system is set up so that most schools are actually two schools in one. There is a morning school from 8-12 that has students, staff and administrators. Then, from 1-5 a completely different set of students, staff and administrators come and have their classes. So we actually only had 4 hours everyday to measure our kids, not 8. Yikes.

Then, quelle surprise, we find out that the week before break is the testing week for schools. Again, a difference between Haitian and US schools- kids take a series of three exams during the school year. These tests determine if a child passes or fails. While students get homework, this isn’t graded and the culmination of grades isn’t from assignments, it’s these tests. Three times a year (December, March and June) students take a week long exam which compiles their grades. So this week was not only important for us because we were collecting our data – it was more important for the children as it decides whether or not they pass their grade. As a result, we realized that while testing was going on, we wouldn’t be able to measure the students. (It would be counterproductive in the grand scheme of things to pull a child out of the most important test of the year to get weighed and measured.) So our second week, 4 hour work days suddenly became 2 hour days. Needless to say I was beginning to get nervous.

So March 4th rolls around (oh yea- we only measure during school days; Monday through Friday) and we begin. To my absolute delight, we completely measure 175 kids. 175 out of 1167 done just like that. Things were looking up. And, to my absolute delight again, my team didn’t let up. The eleven of us were able to hunker down and get all of our kids done in nine days, giving us a day off. I was completely blown away by their ability to focus on the tasks at hand, find a rhythm and rock it. Everyday there was a team leader and that leader was in charge of organizing the kids, setting people’s tasks, and keeping the momentum going.

We had two teams so that we could do two schools at once. We started with the larger schools in order to cause the least amount of disruption during testing. We also tried to coordinate schools by area so that teams worked in schools closer together, allowing less travel and driving around. And it worked. While the teams worked, my counterpart Windy and I drove around making deliveries, bringing supplies, and making sure everything was going smoothly. It was one of the best coordinated efforts I have seen in my limited international work and I was truly impressed. Everyone knew they were part of a team, knew the mission, and worked to get it done.

That’s not to say we didn’t have our hiccups. In the developing world, there are always hiccups and usually these hiccups are chronically occurring. They’re always happening so you have to learn to adjust and work around them. And we eventually did. The biggest bump in the road, besides the crappy road to one of our schools was the testing. Because it was testing week, we started our measurements later, giving the students time to take their tests. However, tests were only an hour or so long. After that, teachers let the kids go home. This meant we had a precious window to catch kids that needed to be measured and quickly get them done. I mean, what kid is going to want to sit around and wait to get prodded and pricked while they have basically a day off of school? As a result, we were always searching for students and always missing some at the end of the day. How did we solve it? Classroom games.

To their credit, most of the teachers at these schools are very helpful. Most. After finishing exams, we were able to get teachers to play games with their students until we were ready for them. Hangman, guessing games, math games – whatever worked. And it did. Kids want to be in school, they like learning and they especially like learning in a way that’s fun and not the standard repetition. I loved it for many reasons; kids were engaged and enjoying themselves, they were staying at the school longer, we got our measurements done, and the schools were involved. A win for everyone.

Yep, our two weeks of measuring was a success. And to end it, we took a staff day to the beach. Granted, it happened to be on a day that was a complete downpour, but once we got over the mountain framing the city, the rains stopped and we were able to enjoy ourselves. The perfect ending to a hard-working week.

Sunday, March 17, 2013

a little bit of my haiti

just a little snapshot into my first couple of months here. the mountains of cap-haitien, scome of the school kids i work with, and the beaches where i get to relax. life. is. good.



Thursday, February 28, 2013

When things work out

Today while visiting the schools in preparation for our mid-line measurements starting next week, my team got a great surprise. My first week in Haiti at one of the schools I spotted a severely malnourished boy. Not only was he extremely stunted (about the same height as a two year old child), his skin was loose and had a ashy color, his energy level was non-existent (what kid doesn’t at least get up for recess?) and he had a fever. All of these are signs of some sort of micronutrient/nutritional problem but put them together and they indicate a possible larger problem of severe micronutrient deficiency.

In other words, this kid was stunted because he didn’t get enough calcium and vitamins a-c-d-k when he was an infant and young child. This could be because his mother stopped breastfeeding before six months or introduced food too early or didn’t watch him eat when he was old enough to eat without assistance or any combination. His skin – the most important barrier in preventing foreign objects like germs, parasites, infection into your body – was poor because he hasn’t had enough vitamin a & c as well as zinc over the years to the point where this barrier is easily broken. Dehydration also impacts the skin. His energy level was low because not only was he not getting enough food, he wasn’t getting enough of the right food such as fruits and vegatables. The Haitian diet is largely made up of rice, corn and beans. Vegetables like carrots, tomatoes, and pumpkin can be bought, but they can get expensive and are not always in the best condition. The fever that he had was most likely due to the fact that he had several infections that hadn’t been treated. These could have come from simple scrapes or mosquito bites or whatever. Your body needs vitamin a and others to fight of infections. When you have little to no vitamin a guess what – you get sick easily.

Besides all of these visible signs that I noticed right away he also likely had others. Diarrhea is common in undernourished children because they are dehydrated, have chronic infections and other illnesses and live in poor living conditions. The water quality in Haiti is also poor – it’s full of ecolli, giardia, amoebas, and other parasites besides dirt, shit and trash. If you drink it, you bet – diarrhea becomes pretty normal. Similarly, sanitation is also more than lacking. The neighborhood this boy lives in is one of the poorest in Cap-Haitien. Many families don’t have latrines (pit toilets you squat to use) and in fact share a common block toilet. (Imagine sharing two or three toilets with your fellow neighbors up and down the street. Now imagine you all have diarrhea and still can only use those latrines. Think they are adequate? They’re not.

So why the digression from nutrition to water and sanitation? Well, they’re intimately connected. You could be the most well-nourished person in the world but if you get diarrhea and don’t treat it, all those vitamins and minerals go out the um, well you know...back end. So while it’s important to be well-nourished, getting enough vitamin a,b’s, c, d,k and minerals like iron and zinc into your system, it’s just as important to be able to ensure they get used by your body and not flushed out.
An over-simplification of micronutrients, but hopefully you understand the complexity of this boy’s situation. He’s been chronically undernourished his whole life and his living conditions are setting him up for chronic illnesses that prevent him from absorbing the things he needs to get better. So he’s sick. And when I spotted him, the team realized that we needed to do something.

While part of the study is to monitor attendance and the health of the participants, there is also a line which we cross if a child is particularly in need of attention. For example, a child misses two days of school because he has a bad stomach ache. We make a note of it but we don’t call all hands on deck. However, a child has shown signs of malaria and has been absent for two weeks. That is more likely to get our attention and we’ll act by taking him to the hospital one way or another (either our nursing team will, school staff, parents, etc). This kid fell into the latter category – he needed to be seen by a doctor and treated right away. So the very next week, one of our fabulous and amazing nurses took him to the hospital where he was diagnosed as malnourished (he was in the 2% for children age 3. This child happened to be SIX YEARS OLD. That malnourished.) as well as having severe infections. He was given antibiotics and his parents were instructed to feed him a specific diet which included meat, dairy products, eggs, and vegetables.

Chances are, the whole family is undernourished. He has three older brothers at the same school as well as four younger siblings. It’s a lot of mouths to feed no matter what country you live in. In Haiti, getting adequate amounts and qualities of food is especially challenging. So, educating parents as well as kids is important. That’s what our nurse did. She talked with the parents and told them what the boy needed in order to get better. And although the parents have hardly any disposable income (really, none at all) they began sending 10 Gourd to school with the boys to buy snacks while at school.

Since these boys are already in the study and are receiving the fortified peanut butter (one of the experimental groups if you remember a previous post) this money can be spent on additional snack food. The nurse in charge of this school – being proactive and diligent noticed this and pulled the oldest brother aside to instruct him what to buy. 5 Gourd is to be spent on bread so that they can put the peanut butter on it (making it more filling) and the remaining 5 Gourd is spent on frozen milk or something similar which is mostly eaten by the youngest brother (the malnourished one). This happened within my first two weeks of being in Haiti.

Having been here for over a month now, I have gotten pretty busy and the little boy, though never completely out of mind has been pushed aside for other things. But today, as I was visiting the school early in the morning before it started I could see three boys running late. I yelled for them to hurry up and as they got to the school I noticed that it was the little boy and two of his brothers. Quelle surprise! The boy was running! A normal thing for a kid to do, but for a little boy who two weeks ago didn’t even get up for recess but preferred to sit this was a sight to see. His whole demeanor was different – he was smiling, talking and engaged.

It was so good to see and got me and my two colleagues pumped up for the rest of the day. Granted, we didn’t do much for him besides get him to the hospital, the fact that he has changed since going to the hospital is encouraging. The school staff, especially the director has been supportive of our project and has begun improvement to the school such as purchasing a water pump and filter for drinking and handwashing (with clean water!), the parents are sending extra money for a mid-day snack for their kids, the nurse is ensuring that he eats the whole peanut butter packet – all of these things are giving him a chance to get better. I can’t wait to see him again.

Thursday, February 21, 2013

Call me spiderwoman

I’m sharing this mostly because I just found out how incredibly stupid I was. Which really isn’t too much of a surprise but still. I have a brain, a pretty good one with rational thought and plenty of logical reasoning capabilities. Yet, I seemed to forget all that and acted like a fool. So I wake up last Saturday kinda late. By late I mean 6:30 as the sun literally shines in my faces too bright to sleep any longer. And yes, that is sleeping in. I usually get up at 4:45. So, sleeping in and taking full advantage of a lazy Saturday I go over to my kitchen to make a little French press coffee and an omelet. There, in my sink, clinging with all eight legs to my French press is a spider. A big spider. Like huge. Like Hobbit eating big.

Not being able to control the girlish shriek that came out of my mouth I then proceeded to do a special heevy-jeevy dance all around my apartment. Then, realizing that yes, I am all alone and yes, that big-ass spider is real- I, me, moi, mwen- I was the one that needed to take care of it. So I thought about my options:

1) Kill the spider

2) Catch the spider, and like the crickets that I capture, fling it from my balcony

3) Leave my apartment for the day in hopes that the spider was just passing through. Then proceed to lay awake for the remainder of my time here in pure fear of waking up face to face with one.

4) Run away, run fast! Move into a new apartment, this one is definitely occupied

Then I weighed my options:

1) If I kill it, how would I do it…shoe? Bazooka? Mustard gas? What if it didn’t die and I made it angry and it came at me like a spider monkey? What if its guts exploded everywhere? And to kill it, I would have to get close. Very close.

2) Catching it, super easy. I have a cup that is reserved exclusively for this activity. Although I only use it for crickets. So getting a much bigger animal into it? Hmm… then how will it be transported without leaving said cup and crawling up my arm to my face?

3) This is not an option. I treasure my sleep and do not want to revisit the week after the mamba was killed behind my hut laying on my bed in pure terror. I had nightmares that a snake a la basilisk style would surround me in my sleep and slowly digest me over the hot season. I can only imagine similar nightmares as a monster spider gingerly weaves a web around me and turns my insides to jelly. Plus, what if the spider, misreading my lack of action in getting rid of it decides to become a permanent resident?

4) There is nowhere to run.

And what did I do with my options? I choose option 1. It. Must. Not. Live. But rather than pick up my one of my heavy shoes, or a brick, or anything that was heavy I choose… a knife. Yes, I picked up a knife and decided that stabbing it to death was my best option. Like I said before, rational thinking did not occur to me. It was a big spider. So with knife in hand I took a couple of deep breaths (somewhere off in the distance I’m pretty sure that Eye of the Tiger was playing) and made my attack. With one terrifying and expertly placed swiped I cut the thing in half. (Nevermind I could feel it struggling beneath me). But then… the front half ran away. Yes, that’s right. The front half of the spider aka the head and four legs ran away. Cutting it in half didn’t kill it. So what’s a girl gotta do to kill a damn spider? Stab it! And yes, that did kill the front half of the spider.

I figured that the spider was just a small baby tarantula. They’re relatively common in the area near my apartment so I figured, cool. A tarantula. I’ve never seen one in the wild. Granted the “wild” doesn’t really mean my kitchen sink, but hey – it’s exotic. I’m really in it now! No, just for fun this morning I looked up pictures of tarantulas and spiders in Haiti and guess what? It wasn’t one. Nope, I had decided to go head to head with a brown recluse. Yep. And not just any brown recluse. I mother-giant of one. Yea, super venomous and I should have probably chosen any other option other than option 1 because guess what – brown recluse spiders can still live even after they lose part of their body. Chopping it in half does not kill a brown recluse, rather, it pisses it off.

After reading up on my little dead friend, I learned the following; I have created a brown recluse haven in my apartment. It’s the right temperature, there are places to hide (under the cabinets, in the clothes piled on my bed, in my dresser, under my bed) and plenty of things to eat. Guess who’s super cleaning her place this weekend? That’s right, this girl. And I won’t be chopping things in half anymore – the shoe it is! And maybe a little bit more rational thinking.

Tuesday, February 19, 2013

Enjoying the Market

There are two markets in Cap-Haitien, one that is smaller and closer to my apartment and the other that is in the center of town, offering everything you could ever need. (That’s not exactly quite true, but it’s huge). Both of these markets have their advantages; while the smaller market has fewer people and crowds, the selection is often limited. The big market has that selection but also has people everywhere all jostling for whatever it is they need. I’ve actually always enjoyed the market. In Senegal, I lived for Sundays—my village’s lumo or market days. I would be able to stock up on bananas for the kids, peanut butter or peanuts for an awesome dinner, and other fruits and veggies. Plus, there were fatayas to eat, frozen milk to gobble up and an over-stuffed car to ride. Even in Podor or Ndioum, the market was always bustling. Walking through the market and seeing the first tomatoes or lettuce of the season always brought a feeling of disbelief mixed with joy. And finding women to shop from over and over again, built up a nice report where I often got a cadeau or gift in return for my patronage.

Though not as easily, I still enjoy the markets here. Part of it is I have yet to master the art of Creole bargaining, although I have been improving each time. Part of it is that they are different enough where I still haven’t found that good ‘ole market rhythm. However, I do enjoy walking around the market, seeing all the oranges and limes and the bright splotches of tomatoes. It is mostly women who work at the market, selling produce or fish or dry goods like rice. So, I enjoy visiting with them as well. I call them Madame, they call me Cherie and I buy my week’s worth of eggs, rice, beans, etc. While there aren’t fatayas here to eat, I have been exploring my options for my go to market snack. There is something called pate pike which is a hot-pocket like item stuffed with a spicy sauce. Fried plantains are also plentiful and each vendor seems to have their own topping.

Exploring the markets, I have wandered upon the area the sells charcoal, mounds of them covering the ground while you walk in between them. The meat area will have pieces of chicken for sale-even a whole chicken if you get it early enough—as well as mutton and beef. The fish market is teeming with the mornings catches- various fish caught with nets, spears and poles. There are always ladies with large basins next to them full of live crab or shrimp. Besides fresh food, there are the dry good vendors who have large sacks full of rice, beans, corn, flour, pasta plus the other items needed to make a tasty meal. Then there are the other vendors who sell soap, powdered milk, paper towels and the like.

At times, the market can seem like a sensory overload. There, fish mixes with citrus, mixes with old vegetables, mixes with garbage. It’s not a pleasant smell and it can easily overwhelm you. Plus, there are always people around, pushing and shoving and working their way through the narrow paths. Plus the noise that comes from small spaces, people shouting and trying to get your attention. But, if you’re able to zone out and push all of the distractions and unpleasant things aside you just might be able to enjoy it.