Sunday, April 23, 2006

Cité Soleil:

In January, three short months ago, Cité Soleil, a slum of more than 200,000 and unarguably the worst part of a brutally poor country, was a war zone, unsafe for the Haitian police or U.N troops, much less white skinned, unarmed NGO workers. Well, it’s still dangerous for the police and UN—crumbled blue and white remnants are all that remain of the destroyed police stations and the mustachioed Jordanian troops sit causally in tanks on the perimeter of the place—but we were able to tour parts of the wretched slum—I know “wretched slum” is redundant but I’m trying to indicate the true horribleness of the place; also my thesaurus has no synonyms for slum, so I’ll be over using this word—in an air conditioned bus with some visiting Americans on Thursday.

Our host has a big presence in the slum, running schools and feeding programs at seven different sites. He and his workers were able to enter Soleil, even during the bloodiest of times. He continues to have an agreement with the gang leaders, who control the nine zones of the slum and have an edgy peace among themselves. John asked a couple of the gang leaders why there was violence before the February presidential election and afterwards, none. The first said that now that Rene Preval is president, they want to give him a chance to succeed and they have some hope for their futures. The second leader, an English-speaking, charlatan named Aaron who kept saying, “Trust me,” much in the manner of a loan shark, said that the gangs from the neighboring slum of Boston, who were backed by the anti-Artistide rich—this much I think is true—were the ones coming in the neighborhood and causing all the violence and since the election, they don’t come around anymore. The gangs in Soleil are sympathetic to Aristide, but surprisingly the first leader said that it wouldn’t necessarily be a good thing if he returned from exile in South Africa as violence could ensue.

I want to describe some of the positive programs we saw in Soleil, but first the negative and, unfortunately, it overwhelms. We walked down a narrow path between blackened, tin-roofed shanties, children following us. An old man sitting on the ground sees John’s scrub top and holds out his hand to him. It is covered with a fungal infection, caused and encouraged by the filth the man lives in. Another man is sitting in a child’s car seat.

The path ends at the ocean—yes, irony of ironies, the most decrepit place in Haiti is beachfront property—with garbage, mounds of it, serving as the beach. Beyond the garbage are piles of seashells coated with so much dirt, they don’t look real. A couple of porous, wooden fishing boats are pulled up on the garbage. Pigs are rooting everywhere. We pick our way carefully back away from the ocean. We come upon a muddy, garbage strewn field with more pigs reigning supreme. The field is ringed by shacks with their tin, cardboard, and concrete look absolutely uninhabitable. I hear crying coming from a shanty. If a sick child lives there, I don’t see how recovery is possible. We stare at the area trying to look casual, like we’re not seeing the most terrible site of our lives. “Unbelievable,” says one man and it is the only word for it. How can it be that people live like this in the 21st century?

A cloud of children is following us, encircling us. They are small and dirty. More than a few boys are wearing no clothes at all. They look at us expectantly and grab for our hands. One of our group races up and down the street with the children following them, screaming in delight. Some things remain the same.

We are going to tour a school. As of the night before, this day preceding the legislative elections, was declared a national holiday. In a country of low employment, we’re not only going to take off one day for the election, here’s two for you. But this is how we found ourselves free to accompany the tour we are on. We had gone to the clinic and discovered that only the nurses were there, who hadn’t heard on the television that everything would be closed today. After having some Cokes with them and conducting a brief English lesson, we left and joined up with our host.

Though schools were closed too, one of the seven sites held class so that we would have something to tour. The children from pre-school to high school in a dozen classrooms in the three story building sang loudly and proudly, welcoming us to their school. Haitians, even the boys, aren’t shy about singing. Besides the learning that goes on, the children and seniors in the area are served a hot meal. If you’ve made it to senior status in Haiti, you’ve really overcome some odds; these folks seemed uniformly joyful. Another of our host’s programs is sponsoring some wayward youth—i.e. former gang members—in vocational school. It was these young men and their leader who gave us their opinions about the cease fire in Soleil. they are learning refrigeration, auto mechanics, building, and electronics.

The last project we toured were rows of houses constructed by our host’s program. These neat little three-room houses with wooden front doors, will be given away by lottery to a lucky few. Lots of people still live in Soleil, but John can tell not as many are here as in the past. Great numbers of people fled when the slum was in lockdown mode, and they haven’t returned.

So good work is going on in Cité Soleil. But it comes at a price. Payoffs, corruption, theft, and personal risk are some of the costs. Close to a dozen workers and individuals involved with the program have been killed over the years. One of them Emmanul Dred Wilme, was considered a notorious gang leader by authorities and he was gunned down a few months ago police and UN bullets finding him. Inside Soleil, Dred was a folk hero and the main road into the slum has been renamed after him. One man’s terrorist is another man’s revolutionary.

As we leave Cité Soleil, we pass the rare building that isn’t pockmarked with big bullet holes, as the police and UN feeling under siege, fired indiscriminately, with the gangs responding in kind. How many innocent people were killed? Lots of other innocent people die prematurely every day in less dramatic ways. We salute our host for helping all of these people through his work in Cité Soleil.

Waiting on Haitians:

We have been the ones waiting this trip: waiting for Fastina, Katia, and Nadia to show up or otherwise contact us. Finally, they arrived separately within 24 hours of each other, a few days before we are to depart.

Fastina is a 13-year-old child who is coming to the U.S. for her second heart surgery. Much like Jackson, she had a faulty mitral valve, which was repaired in 2000, and now needs to be replaced. Fastina has been accepted by a hospital for this surgery and all the necessary letters for the visa are in Haiti. We only need to connect the papers, Fastina, and a consulate official. We had hoped this would happen before we left, but we won’t be bringing Fastina to the States until May at the earliest.

The good news is that when she and her mother showed up this morning, Fastina looked good and was in stable condition. She can’t walk too fast or too far, and as Jackson showed us, these kids can deteriorate quickly. We don’t want to delay.

Katia is a young woman who had her aortic valve replaced in 2004. We see her regularly to give her medicine. We had heard that Katia was very sick; she had lost weight and her eyes were yellow. Uh oh. We then discovered that Katia was in Jeremie, a painful 12-hour tap tap ride away, staying with her grandmother. Katia’s mom was going to get word to her that Dr. John is in Port-au-Prince.

Katia, also showed up this morning. Her mother went to Jeremie to fetch her. The crisis had passed for Katia, but what she described was not pleasant. “I felt like a fire was burning inside of me and that my head was going to fall off. I couldn’t think,” she said, highly emotional. With her low hemoglobin level, jaundice, fever, back and head pain, and lack of appetite, she described classic symptoms of malaria. Upon exam she looked healthy, her heart sounded good, and her blood pressure was normal for her. Katia had gone to Jeremie because some of the 500 Cuban doctors in the country practice in this town on the southern peninsula. However, while she was there, she never saw one of those doctors. She calmed down as John told her, “You are not crazy. You are going to live,” and we gave her a new set of medicines and a little money.

Nadia is Jackson’s 19-year-old younger sister. She came yesterday morning. There is nothing we can do for Jackson anymore, other than honor his memory. But we do have a suitcase full of things for Jackson, including pictures from his funeral, and some money to give the family.

The first thing Nadia wanted to do was see the pictures of Jackson. This was traumatic and she began crying. She had earlier wondered if Jackson was really dead, and the pictures provided evidence of this painful fact. Jackson doesn’t look much like himself in the pictures. His last days at Cleveland Clinic were rough on his spirit and his body. Through her tears, Nadia said that Jackson was the only big brother that she had and that he had had hope when Dr. John arrived in Port-au-Prince. We made arrangements to have Nadia come with a vehicle on Saturday morning; we are going to take the suitcase to her home and pay our respects to Jackson’s mother.

Saturday, April 08, 2006

From Bonjour to Buenos Dios

Hola from the Dominican Republic where we´ve come for a few days R ánd R. The two countries occupy this island in an uneasy fashion. The DR is Spanish speaking and much more prosperous than Haiti. Many Haitians work in te Dominican sugar fields near the border, where they aren´t treated well. While the Dominicans are very friendly to us Anglos. I don´t think this hospitality extends to the Haitians who are often looked down upon. Improving conditions in Haiti would benefit both countries. Hopefully, with the fresh start a new president gives, this can become a reality.

It took us about seven hours to drive here from PAP. We had a couple stops at the border where we had to pay 35 dollars each to enter the country. The road through the DR is much smoother than in Haiti and actually has white lines painted down the middle. The DR is more militarized than Haiti. We went through several checkpoints where soldiers with big guns checked our passports. They were friendly and as we got closer to Santo Domingo, the capital, they became more lax, waving us on through when they recognized our friend who was driving. He is Dominican but in a truck with Haitian plates. At one of the stops, he bought some mangoes for his girlfriend, a huge bunch of them for a dollar fifty U.S. John bought the most delicious cashews I´ve ever had in my life at another stop. We gave a ride to four soldiers in the back of a truck. Some of them were hauling bags of rice home to their families.

Our friend was a daring driver, as most drivers from developing countries seem to be. All I can say is there has to be a lot of God´s grace streaming through traffic in Third World countries. This is the only way to explain why there aren´t accidents every other second. I think car accidents are one of the leading causes of death in poor countries, and I know there are a lot, but not as many as there should be. Between the sudden stops, the lurching lane changes, the creative creation of new lanes, and the heading at highway speed directly toward another car speeding toward you, while it is flashing its lights, as you pull over into the other lane with feet to spare, well, all I can say is ai ya yi ya yi.

The DR is much greener with more trees than in Haiti. We followed one large truck that was full of tomatoes. We also saw several Caterpillar machines, mainly doing road work. The villages we passed seemed poor, but again, not as poor as those in Haiti. Some of the houses were constructed in wood and painted in bright colors. People sit out on their little front porches and talk. Right inside the border, we passed one area that was completed flooded out in 2004. Of course, Haitians lived in this area, and their homes and lives were swept away in the water. We saw the remnents of a concrete bridge that washed away, its naked base bereft of the actual bridge, so it obviously was a fierce flood.

The DR is so ethnically diverse. We see people who look Spanish, Mexican, Anglo, Indian, Haitian and they will all be Dominican, speaking Spanish. There is something so cool and universal about this. You cannot make any assumptions based on people´s apperances. We are going to explore the historic section of Santo Domingo this afternoon. More on this later.

Wednesday, April 05, 2006

Noisy Nights and Days:

The combination of noises last night—whooee! It was a cacophonous racket. We had a roomful of Guatemalans next door to us. They were talking animatedly and had the TV up loud on an American channel. A infernal pump of some sort directly outside our window churned noisily on and off all night. And then sounding as if it was coming on the other side of our front door was a hyena-like coughing and gagging. The poor person had bouts of these sick, desperate- sounding noises every 20 minutes or so.

At one point, being a doctor and all, John got up to check, but could not find the source of the sounds. We think they are from a man staying in a room across from ours. We met him yesterday. He is a Canadian citizen from a French speaking province and of Italian descent who has a business in Haiti. John saw him at breakfast abusing one of the waiters and thinks he could be manic/depressive. The man said he is hiding out here because the U.N. is trying to kill him, which seems highly unlikely, but then again, this is Haiti so you never know. Even more preposterously, he claims that the U.S. is going to invade Haiti this summer and make it an American protectorate and that Aristide will be returning soon. He said he has proof of all of this. Anyway, I incorporated his coughing—or whoseever it was—into my dream. John and I were on a ship in complete fog. The only thing we had to guide us was this coughing but we couldn’t tell which direction it was coming from.

Despite the noisy night, we both got decent sleep and made it to clinic only to find that conditions there weren’t much better. Lots of moms and kids in the waiting area and the babies had the crying volume up full blast. Both John and Dr. Jean-François were seeing patients in an 8x8 foot room. About six nurses were trying to organize the chaos in the waiting area, including weighing the patients and taking their temps. These nurses bring in the patients’ dossiers and for some reason today, they were coming in the room every few minutes to shuffle through the dossiers. This made it difficult to thoroughly examine the babies. John brings a heavy-duty antibiotic, ceftriaxone, brand name Rocephin, from the U.S. which is given by injection. He reserves this medicine for the sickest children, and only one of the three babies he ordered an injection for got it.

“You know what this place needs is Six Sigma,” I joked to John. “CAT should send a team down, train some black belts, and whip this clinic into shape.” Har-de-har-har. One of the realities of practicing medicine in Haiti is the frustration of working in a less than ideal environment. Supplies, order, and skills are all lacking. While most environments are far from optimal in Haiti, in the field of medicine, these gaps can contribute to life and death—mainly death—consequences. American clinicians who practice in Haiti have to decide what they can tolerate. John remembers one doctor from an academic institution, who volunteered with a medical mission group. He flew home earlyt and wrote the group leader a letter charging him with malpractice. Well, yes, by U.S. standards it might have been, but in Haiti the team probably saved lives.

Perspective helps. The following prayer by Archbishop Oscar Romero from El Salvador, who was killed for his insistence on justice for the poor and his criticism of the death squads, provides it:

It helps now and then, to step back and take the long view. The Kingdom is not only beyond our efforts; it is even beyond our vision. We accomplish in our lifetime only a tiny fraction of the magnificent enterprise that is God’s work. Nothing we do is complete which is another way of saying that the kingdom always lies beyond us.

No statement says all that should be said.
No prayer fully expresses our faith.
No confession brings perfection.
No pastoral visit brings wholeness.
No program accomplishes the church’s mission.
No set of goals and objectives includes everything.

This is what we are about. We plant the seeds that one day will grow. We water seeds already planted knowing that they hold future promise. We lay foundations that will need further development. We provide yeast that produces effects far beyond our capabilities. We cannot do everything and there is a sense of liberation in realizing that. This enables us to do something and to do it very well. It may be incomplete, but it is a beginning, a step along the way, an opportunity for the Lord’s grace to enter and to do the rest.

We may never see the end results, but that is the difference between the master builder and the worker. We are workers, not master builders, ministers not messiahs. We are prophets of a future that is not our own.

The picture above is of Archbishop Oscar Romero from El Salvador, an outspoken advocate for the poor. He was assasinated while saying Mass in 1980.

Tuesday, April 04, 2006

Dukens and Mirterlande: Lessons from Two New Heart Patients

Pierre brought his friend Dukens Desir to see John this morning. Dukens is 16. He is so slight, he makes Frandy, another skinny HH patient, look robust. Dukens’ upper arms are as thin as his forearms.

This young man is another victim of rheumatic fever. “He has as bad of a heart as I’ve ever heard,” said John, removing his stethoscope from Dukens’ chest. Dukens sits on the edge of the bed, his shirt off. “Do you see how the left side of his chest is bigger?” asks John. “His heart has gotten so big, it is pushing out his chest.” Holding his finger low on the left side of Dukens’ chest, slightly higher than belly button level, John says, “See my finger pulsate? The heart isn’t supposed to be beating down here.” As John has said many times, “A big heart is a bad heart.” Dukens has two bad valves, which cause his heart to overwork and stretch out. If his valves were fixed, though, he could be a new boy.

John introduces me to Dukens, who gives me a smile that contains all the sweetness and gentleness in the world. I am hooked. We have to help this boy even though Dukens’ situation lacks all the conditions that I think are ideal for HH patients: he’s a teenager and they don’t want to return to Haiti after surgery plus they can have behavior problems. He has a valve problem not a congenital problem. This means that if his valves were replaced with artificial ones, he would need to be on blood thinners for the rest of his life. We are finding that even when we supply the medicine, Haitians compliance with taking it is poor, to say nothing of periodically getting their blood coagulation function checked. Poverty makes everything difficult. This leads us to want to find adoptive American homes for these kids, another huge, hassle producing process. In other words, Dukens is not a small child with a congenital problem that can be completely fixed with surgery.

Yet, despite all this, I want to find help for Dukens. His eyes are bright and I think of all that he could do with his life. “Should we get an echo on him?” I ask John. “We have six more just like him on the list with no hospital,” he responds, serving as the voice of reason.

Rheumatic fever is a scourge upon the hearts of young people in developing countries. The disease develops from untreated strep throat. Strep throat can be cured with a few pennies of antibiotics, which these kids don’t get. I’ve looked on line for rheumatic fever prevention programs and have discovered that to prevent and eliminate this disease, the overall health care of the citizens need to be improved. People need regular access to doctors and medicines. Until that happens, rheumatic fever will continue to kill people, as it did in the United States before the advent of antibiotics.

Pierre gives us a ride to the clinic. On the way, John explains that we don’t have a hospital for Dukens. “I will hope that you find a hospital,” says Pierre. “Dukens is suffering.” Yes, John agrees, Dukens has been sick for a long time and suffers a lot. “It is very hard to watch him suffer,” continues Pierre. So hard, indeed, even for me, who has known Dukens for all of ten minutes. I am trying to staunch the tears.

Dukens and his father get out of the van. I turn to shake hands with him. He beams at me again. It is hard to know that smile will soon be extinguished from this world.

* * * * * * * * * * * * * *

This same morning, shortly after I finish writing the above, I notice a man standing in front of me where I sit on a ledge in a hallway between two waiting areas of the clinic. I look up and the man smiles and hands me a business card with John’s name written on the back. I flip the card over and see that it’s from Dr. Richard Pilie, the cardiologist in PAP who does echocardiograms of HH patients.

A few minutes later, I escort this man, a woman, and a teenage girl into John’s exam room. The woman is carrying a written echo report and the cassette that contains the actual echo video of the teenager. As usual, John wants to do a physical exam of the girl before he reads the echo report.

The girl’s name is Mirterlande Trompe. The two people accompanying her are her uncle and her sister. Her parents are in the province (country) near Hopital Albert Schweitzer, where John used to work. She is 14-years-old and looks healthy, or at least a lot healthier than Dukens. John introduces her to me, and she glances quickly in my direction. She’s shy and nervous, so making a connection is more difficult.

John moves the scope all over Mirterlande’s chest. As he has her stand to listen through her back, he says, “Her heart is large.” After a couple of minutes, he has her sit down. “It’s her mitral valve,” he says. It’s not working and blood is flowing in the wrong direction. “Rheumatic?” I ask. He nods.

I hand him the report, which confirms John’s diagnosis. He reads through Dr. Pilie’s surprisingly lucid handwriting. “He has her on all the big gun heart medicines, but not penicillin,” John says wonderingly. People who have had rheumatic fever should take penicillin everyday for the rest of their lives to prevent a reoccurrence. Jackson likely had more than one bout of rheumatic fever. John tells her uncle to stop by our place and we will give them some penicillin.

At the end of the exam, I catch Mirterlande’s eye and smile. She smiles back a little. She is lovely.

Here is the lesson: I don’t have as much of a feeling for Mirterlande as I do for Dukens, who has more advanced disease and two bad valves. I simply have more of a response to him. My thought about her situation is, “Not another valve.” It’s an unattractive human reaction. How I feel doesn’t change the facts: Dukens and Mirterlande both deserve good medical care and surgery. We shouldn’t rank people based on how we feel about them.

As human beings, we are inclined to want to help those to whom we have a closer attachment. We ought to realize the urgency of everyone having good health care, even if, especially if, they are poor people whom we don’t know or have never seen. This is God’s way, to strive for, and not our human way, to overcome.

The coincidence of seeing these two patients within an hour of each other makes me think that God is trying to send me this message about my desire to help Dukens but to label Mirterlande as a troublesome valve case. I become certain when John tells me the Creole meaning of her last name, Trompe: to fool.
Musings on a Morning Walk

Yesterday morning on the way to Grace Children’s clinic, I heard a boy yelling from behind, “Hey you! Hey you!” When people talk to us on the street, some of the time we don’t respond with more than a smile because if we do, it just encourages them to ask for things. But this boy, about 9 came running up to us, saying to me, “Give me a dollar!” I replied, “Mwen pa gen larjan.” I don’t have any money. So he said, in Creole this time, “Give me something to eat.” This seemed like a reasonable request, and I did have one of my protein bars with me, so I pulled it out of my back pack and gave it to him. He said “Thanks,” with a big smile and went running back where he came from to show a friend, with whom I hope he shared it. I’m always a little afraid the Haitians won’t like the protein bars. Their cuisine is so delicious and these bars seem like fake food. At least they are covered in chocolate.

“The trash pick up hasn’t any improved any since the elections,” remarked John on our walk. Boy, is he right. Stinky garbage of all sorts blankets the roads and sidewalks. The dirtiness of PAP is probably its most noticeable characteristic. “Paris of the gutters,” one wag described the city a long time ago, and even this is a charitable description. We watch a man walk through a stretch of road that is especially hard to negotiate, given the puddles, trash, and mud. He hugs a wall by the side of the road, treading his way on a narrow, dry path that I had never noticed before. We follow. We turn right to hike up a short but steep hill. At the top, I see two thin rusty metal poles in the form of a cross. Calvary. This march reminds me of Calvary. All of Haiti reminds me of The Way of the Cross.

On the way home from clinic, we retrace our steps, walking by a large, partially completed, abandoned house, where squatters live. A little girl about five dressed in a filthy gown that was once white watches us with interest. Her hair is tinged orange, a sign of malnutrition. I have nothing to offer her.

This little girl makes me think: Does God punishes us individually for structural sins, sins of history, sins that have been centuries in the making, like poverty, slavery, and unjust wars? Certainly I am not personally responsible for this little girl’s pathetic life. But how responsible am I to improve it? I benefit from the arrangement of the world that is so cruel to her. Of course, I can’t help where I was born. Neither can she. What does God call me to do about this situation? These are questions we must grapple with.

Earlier in the day I gave a little boy my protein bar. And this was something, not much but something, the minimum good, I could do for him, a work of mercy. Works of mercy are individual acts responding to an immediate need, while works of justice fundamentally change a system that is unfair. Works of justice are harder to implement and their positive consequences are longer in the making. For example, I might work for a micro bank and give the little boy’s mother a loan to start a business. With the proceeds from her business, the mother buys food for her son and puts him in school. My work at the micro bank would promote acts of justice. I find justice to be more complicated then mercy, but equally important, if not more.

And I also wonder if this little girl gets extra credit from God from all the suffering she does on earth, a kind of celestial affirmative action. I know this runs counter to our notion of individual responsibility, but the playing field is so uneven. Sometimes we will see a person suffering in the extreme, like the poor man who seems to live against the wall of Grace Children’s Hospital. Dressed in rags, he acts mentally impaired and probably only gets by due to the generosity of the people who pass him each day on the street. “That guy is going to heaven,” John says. Religion isn’t really an “opiate of the masses;” but often allows the elite to justify their behavior.

We aren’t helping everyone who needs it. The only way to figure out any justice on an eternal level is to believe there is a heaven where this poor man and all the children will be welcomed as guests of honor.

Sunday, April 02, 2006

One Child At A Time:

We walked to church at the Missionaries of Charity, dodging piles of garbage and polluted puddles covering the road. Because we forgot Daylight’s Saving Time started today, we arrived at the 9 am service an hour late, right as the homily was beginning. For those of us familiar with the length of the Mass in the U.S.—if the priest goes over an hour, we start to fidgeting—it’s humbling to know the Haitians aren’t in a hurry to get home to their televisions.

The MC’s, Mother Teresa’s sisters, run a home for abandoned children. The 9 am Mass is the children’s Mass, and the open air church is filled with row after row of boys and girls sitting on benches. Today most of them are wearing grey t-shirts, perhaps because it’s Lent. Not all of these children live in the home; many are from the neighborhood.

Some sights are unexpectedly touching, like the little girl in the white dress with the broken zipper. Her dress is pinned at the top, leaving part of her back exposed. It’s her Sunday best. Most of the children are well-behaved but I see one exception as a girl turns around in frustration, swatting at the retreating hand of a boy. Kids are funny; they haven’t become captives of culture yet, so there is a universality about them and their behavior. Another little girl with her copper colored skin, wide set eyes and thick black hair hanging in a braid down her back must have Arawak blood in her. The Arawaks were the original inhabitants of Haiti before Columbus introduced them to genocide and smallpox.

After Mass, John leads me through the serpentine hallways of the Sisters’ home for the children. Though John used to be a frequent visitor, in all the times I’ve been to Mass here, I have yet to visit the home. It’s a good thing to do. Even in Haiti, I can avoid hard sights if I want to. Averting our eyes from the suffering of others seems to be a human instinct. If we don’t see it, we don’t know about it and we aren’t required to do anything about it, or rationalize it, or live with our guilty consciences.

What is a more difficult sight then suffering orphan children? We walk through several rooms: one has 25 cribs containing the sickest babies; 15 babies are in another room; another has 11 babies, and another 16. One of the children is covered by loose, scarred, scaly skin. His eyes protrude from their sockets and are covered with an opaque membrane. They dart from side to side, clearly unseeing. He has a large protrusion from the base of his head. He looks as if he has been burned but one of the Haitian workers in the room tells us it is a congenital condition. He is crying, but as John strokes his back, he quiets. These children crave the touch of skin. I pat another sobbing boy. He looks at me with sad, searching eyes as if to say, “I didn’t bargain for this.”

The good news is that the Sisters are taking excellent care of these children. The rooms are clean and well organized. Under each crib is a basin of water with a rag, the child’s own wash water, which avoids germs being spread from baby to baby. The pharmacy is well-stocked. As we visit, large dishes of chicken, rice and beans, potatoes, and vegetables are being ladled out. Four boys old enough to feed themselves are sitting in a row on a blue mat on the floor, shoveling in the food. The babies have to wait until a worker can reach them. We pick up one small girl and feed her. As I hold her on my lap, I can feel her lungs rattle with each breath. TB? Pneumonia? Asthma? Just a cold?

Taking care of these children is hard work. It is also the most important work, and should be recognized by everyone—individuals, governments, churches—as such. But the Sisters are not in it for worldly recognition. Still, they are human and at times the need must seem overwhelming. A prayer tacked on a door perfectly addresses this human fraility:

I was regretting the past and fearing the future.
Suddenly, my God was speaking:

"My name is I AM.”
He paused. I waited. He continued.

“When you live in the past, with its mistakes and regrets, it is hard. I am not there.
My name is not I was.

“When you live in the future with its problems and fears, it is hard. I am not there.
My name is not I will be.

“When you live in this moment, it is not hard. I am here.
My name is I AM.”

Saturday, April 01, 2006

My Life in the Middle Ages: A Survivor’s Tale--A Book Review

Here is the next entry in my ongoing series of book reviews.

I went to the Pekin Library in search of another book, Mediated, which I will review later on this trip, and wound up checking out three other books: The Good Life by Jay McInerney, Let Us Praise Famous Men by James Agee and James Atlas’s memoir, the subject of this review.

My Life In the Middle Ages is a series of essays about an upper middle class New York writer. The book was inspired by articles on his life that Atlas wrote for The New Yorker. I remember reading one, about his children’s private school. It was a good relic of a certain upper middle class New Yorker kind of a life, fascinating and privileged, but also insulated and thus lacking perspective. As New York is the center of the universe, though, it’s good to keep abreast, so I gave the book a try.

Each chapter has a theme which is helpfully indicated by its title: Money, The Body, God, Death, 25th Anniversary. In many ways, the author is the typical intellectual yuppie boomer who came of age in the sixties. I guess it’s hard not to seem self-absorbed when writing a memoir but Atlas’s self-absorption is a little annoying, tinged with self-pity as it is. He intellectually seems to recognize his privileged position but is somehow disappointed when he doesn’t measure up to some of his high octane New York peers and friends. This “poor me” attitude especially rankles, as I think about the book in Haiti. I know the author didn’t have the Third World in mind when he sat down to write, but a few compassionate thoughts about those who’ve had it worse than he has would have served his book and his life well.

My two favorite chapters were the first one Mom and Dad about his father’s illness and death and another entitled Failure. His father, a physican enchanted by poetry, especially that of Yeats, seems a charming character. But Atlas seems ashamed that his father is merely a physician and not more accomplished like his friends’ fathers. His father provided the line from the book that has stuck with me. Atlas’s father and mother followed a health regime, which included healthful, light eating, maintaining as he put it, “a thin edge of hunger.”

In “Failure” Atlas describes getting fired from a major magazine writing job. In this chapter, he explores the process of accepting one’s limits, which truly seems to be one of the development tasks of the middle years. Atlas stops writing fiction and devotes his time and energy to areas that better suit his talents, like writing biographies and non-fiction articles. This recognition of our limits is a good lesson for everyone past 40.
John’s Brown Bag:

A couple Haitian Hearts patients have stopped by. We saw 27-year-old Suze yesterday. She is special to me in part because I was involved in her case from the beginning to now. My cousin, cardiologist Dennis Killian, along with surgeon Bryan Foy got her and another young woman, Katia, accepted at Provena St. Joseph Medical Center in Joliet and along with John were her physicians in the U.S. I helped John get her visa, the granting of which was one of my happiest moments in Haiti, and Suze stayed with us a couple of weeks before surgery. She is a very elegant young woman who deserves more opportunity than she has in Haiti.

Because of the inequities of our situations, I feel extreme guilt when I see Suze. She knows what life is like in the United States, the unbelievable, extravagant wealth. And she knows how little she has in Haiti. I think it is difficult for her to be motivated in Haiti, now that she has seen how we live in the U.S. The catch is is that if Suze were to come to the States on a regular visa, her life would not be nearly as cush as it was when she was here as a heart patient, staying with a doctor’s family, having all of her needs and most of her wants effortlessly met. She has friends and a community here and though she probably doesn’t believe it, in some ways her life here is better than it would be as an immigrant working two minimum wage jobs in Florida.

The good news for Suze is that her health is excellent and she looks fabulous. She was so thin and sick before surgery. She has put on weight and looks really good. Before coming to the U.S., she just wanted to live. Now, she wants to live, but in the U.S. Who can blame her?

Katia, on the hand, according to Suze is ill, thin with swollen feet. Something doesn’t sound right. The plan is for Suze and her friend to pick up Katia and bring her here this morning. Katia looked good when John examined her in December, so we will see what is going on with her.

Oh, the title of this post? Well, John has this great brown satchel where he keeps all of his medical equipment. It’s made of soft, weathered leather and is the best traveling bag. It is literally his office and allows him to examine patients who stop by or find us wherever we are.

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Suze came by this morning. She left her home in Carrefour at 6 am and took four tap taps a total of three and a half hours to Katia’s home, only to find that Katia wasn’t home. She has gone to Jeremie, a town on the southern peninsula of Haiti and at least a 12 hour rough ride away. According to Katia’s mother, they have relatives there and Katia went to stay with them. Katia’s mother is going to try to get word to her that John is here and would like to examine her. On a walk to the store today, we bumped into Karen a Canadian missionary who lives year round in PAP. She had seen Katia recently. Katia told her that she wasn’t going to return to school for the second semester, but hoped to enroll in a computer course soon. As for Suze, John’s exam confirmed her appearance: she is in good health.