Cancelling a Trip to Haiti to Help a Haitian?

My husband John was scheduled to leave for Haiti two days ago. He was packed, ticketed and ready to leave for the aiport at 10:30 the night before his early morning flight.

But Katina is in the house (U.S.) and she will likely have surgery sometime in the next couple of weeks. John is her medical guardian and has to give verbal consents for surgery and pre-surgical procedures, which, because of Katina's sickle cell anemia, are more complex than usual. Katina is 14, but weighs only 66 pounds. Her heart condition, sickle cell, and socio-economic condition are the main reasons she is so small. But she is smart, smart, smart and a delightful girl. After she has a new mitral valve put in, her heart function will improve and this will hopefully permit her to put on weight, as so much of her energy will not be going to her cardiovascular system to compensate for her sick heart.

Although phone communication between Haiti and the United States is greatly improved from several years ago, when John had to hope that clouds wouldn't interfere with his calls from a satellite phone, a clear, a consistent line cannot always be guaranteed.

So John postponed his trip.

We will keep you posted on Katina

Catching Up with the News

A few weeks ago, Clinton, pictured above with UN Secretary-General Ban Ki-moon, Haitian-American singer Wyclef Jean, and most importantly, a sister we know and beautiful Haitian children, traveled to Haiti.

In the above picture, which I found at Wyclef Jean's website, Clinton and company are visiting an oasis in Cite Soleil run by the Daughters of Charity. In their complex, the Sisters have schools, a medical clinic, programs to teach women how to sew, a malnutrition program for children and other things I know I am forgetting. In the squalor and harshness of Cite Soleil, the Sisters' place is a calm, beautful setting where people are safe and cared for, at least for awhile.

John has volunteered at their medical clinic. It is one of his favorite places to work in all of Haiti.

Clinton traveled to Haiti, where he is very popular, thanks to his role in restoring Aristide to power in 1994, to encourage the international community to invest in Haiti. There are a lot of people in Haiti who want work and who will work hard.

Also in the news recently was Cardinal Francis George of Chicago's welcome call for President Aristide to extend Temporary Protected Status (TPS) to Haitians currently in the United States. Here's an excerpt from the Cardinal's excellent letter:

Haiti meets the standard for TPS because it has experienced political tumult, four natural disasters, and severe food shortages in the last year, not to mention the devastation of Hurricane Jeanne in 2004. In April 2008, starving citizens took to the streets to protest rising food prices, causing political instability.

In August and September 2008, Hurricanes Gustav and Ike and Tropical Storms Fay and Hanna passed through Haiti, causing severe damage and the death of close to 700 persons. Massive flooding from the storms has destroyed homes, crops, roads, and bridges, and largely rendered areas like Gonaives inaccessible to relief workers. Over 90 percent of Haiti has been impacted. Tens of thousands have been displaced, and the fate of thousands more is unknown. More than 300,000 children have been affected.

As the Cardinal goes on to say, the conditions in Haiti are as bad as or worse then El Salvador, Nicaragua, and Honduras, where TPS was recently extended.

Here's hoping the Cardinal's letter helps.

Ronald is USA Bound!

Whew and Finally! Ronald received his Haitian passport and then after a few tense days, a U.S. visa, so he can come to the States for heart surgery.

Ronald is in the process of being adopted by an American family and because that paperwork is pending, the U.S. consulate in Haiti was initally dragging their feet on granting a visa. But then they saw the light (i.e. there might not be any boy to adopt if he didn't have heart surgery and soon) and issued him the visa. His American advocate in Haiti, his host and adoptive family in New York, Dr. John Carroll of Haitian Hearts, and other interested people worked hard to get Ronald accepted at a hospital and then to secure all the necessary approvals. Thanks to all!

We are very happy! Ronald should be in the good, old US of A sometime this week. We will have updates on his situation.

Practicing Creole

For all the time I've lived in Haiti, I should be a better speaker of Haitian Creole. But my Creole is broken at best.

I was able to communicate with my son Luke, who was three-years-old when we spent seven months in Haiti awaiting the finalization of his adoption. And I am able to talk some with 30-year-old Heurese, who is currently living with us. I seem to be able to make myself understood to her, but it often takes me awhile to fully comprehend what she is saying. I say, "Mwen pa comprend" a lot.

I think Heurese understands and speaks more English then we realize. Between my limited Creole and John's fluent Creole, she isn't having to speak as much English as she would with most American families.

To our shame, Luke remembers none of his Creole; he can't even pronounce the words properly. I am hoping that with Heurese here, he will pick up a little of his native language.

Speaking of Heurese, John conducted an interview with her that is posted on his blog. It's very interesting and tells a lot about what life is like for poor Haitians.

The Difficulty of Getting a Haitian Passport

A Haitian passport can be very difficult to procure. We have a patient, 16-year-old Ronald, who has been accepted for heart surgery in the United States. Ronald is very sick and getting sicker each day.

Ronald was accepted by the hospital two months ago. His American advocate hears various excuses when she attempts to get his passport in Port-au-Prince. Or she is told to come back another day and the passport will be ready, and then it isn't. We have heard that Haiti is out of the blue books that are used to make the passports.

When we were waiting in Haiti for our son's adoption papers--and at least this wasn't a matter of life and death--one of the things we needed was a particular agency's stamp. For weeks we were told that the stamp was broken and a new one was on order from Germany.

Excuses like "we are out of blue books" or "the stamp is coming from Germany" are hard to believe. It's difficult to know whether we're dealing with bureaucratic incompetence or bureaucratic lying.

In Haiti, we've noticed a lack of urgency about situations that are considered crises in the United States (like children dying). Perhaps this is because it happens too often.

We hope Ronald gets his passport soon.

Katina is Patient #137

Hurray! Thirteen-year-old Katina has been accepted by a medical center in Ohio. This will be her second trip to the United States. Katina came to Peoria in 2002 and had her mitral valve repaired. Now this valve needs to be replaced.

Haitian Hearts has been monitoring Katina in Haiti for the past seven years. We know her particularly well because she spent eight months in Peoria when she was here in 2002. She is a sweet girl from a loving family who has been attending school regularly. The children and families from St. Thomas the Apostle Grade School in Peoria Heights helped financially support Katina's education and pay for other necessities.

Katina already has her Haitian passport so as soon as the paperwork from the United States goes to the U.S. consulate in Port-au-Prince and she is granted a visa, she will travel to Ohio. We are thrilled that she is getting this opportunity to have her heart fixed for good!

Haitian Creole

There were Haitians in the house last night--five of them. I loved hearing their laughter and their Creole; it was like a party. Haitian Creole (or Kreyol) is one of two official languages in Haiti, the other being French. Not everyone in Haiti speaks French but everybody speaks Creole.

I remember reading a fascinating account of how these Creole languages evolve. Here's what I remember as it applies to Haiti. When slaves were brought from West and Central Africa, they spoke different tribal languages. Not only could they not initially understand the French, they often couldn't communicate with each other.

The slaves began learning a rudimentary French so that they could understand the slave masters and talk with each other. The first version of this language was called pidgin; it was no one's native language. The next generation of speakers makes this language their own and it develops into a more sophisticated creole language. In the case of Haiti, much of the vocabulary comes from French while the grammar more closely follows the African languages. As a written language, the words in Haitian Creole are spelled phonetically. For example, "yes" which is written "oui" in French is written "wi" in Creole. Makes more sense, don't you think?

We had a houseful of Haitians because three young people came to visit Heurese and after a few months in the United States, I know she enjoyed hearing Creole spoken by Haitians. The youngest Haitian, our son Luke, slept right through it

Heurese in Peoria

One of our most recent Haitian Hearts patients, Heurese, is continuing her recuperation from surgery with us. As you can see in the above picture, she looks great and hasn't felt so good in a long time. It's amazing what a difference a functioning heart valve makes!

Heurese is a lovely, soft-spoken woman who is a pleasure to be around. She understands a lot of English. I am trying to communicate with her in my broken Haitian Creole, and we're pleased that Luke will hear his native language.

Heurese is a wonderful addition to our home.

Is the United States Racist?

I'm in Florida today, which is as close as I'm going to get to Haiti for awhile. It's a good time to contemplate a couple of things about Haitians who reside in the United States. First of all, there are close to 1,000,000 of them. This group of people is referred to as the Haitian diaspora.

When I think about how Haiti manages to remain even a little bit functional, I, and others, come to the conclusion that it is because of the estimated $1.2 billion that Haitians in the United States send back to their families in Haiti. These remittances total one-third of the Haitian economy.

TPS, or Temporary Protected Status, is the second thing to contemplate regarding Haitians in the States. According to the U.S. Citizenship and Immigration Services website, TPS can be granted by the U.S. government to people from countries that are experiencing "ongoing armed conflict, an environmental disaster, or other extraordinary and temporary conditions." Before he left office, President George W. Bush extended TPS for the citizens from El Salvador, Honduras, Guatemala, and Nicaragua.

Wouldn't you think that given Haiti's four back-to-back hurricanes in 2008, on top of a whole lot of other problems, that its citizens might qualify for TPS? Haitians might qualify, but they weren't granted TPS.

Why? Given the other nationals that we've extended TPS to, there is no credible answer to this question. Haiti definitely has suffered from repeated "environmental disasters." If you worry that granting TPS to Haitians would causes masses of them to sail for Florida, recent history refutes this. According to the Miami Herald, in the 1990's, the Clinton administration allowed 50,000 Haitians to stay in the country; there was no big deluge of immigrants.

Really, if you look at all the evidence, the only conclusion you can come to is that Haitians are denied TPS because of racism.

There is no other answer, and I take it personally.

Carnival!

Nobody does Mardi Gras or Carnival, like Haiti. It's a whole season of partying, culminating today, in Fat Tuesday. The whole country will be one big party with many coming from the States to join in the festivities.

For Richard Morse, the owner of the fabled Hotel Oloffson and leader of the Haitian band RAM, Carnival is a busy time, with his hotel busy and the band playing all over the country. Richard posts regularly to the Corbett list and his comments are always interesting. Here's recent example that has nothing to do with Carnival

When the population eventually rises up and puts an end to Haiti's archaic economic system, controlled by the Gang of Eleven, controlled by "Friends of the Embassy", people will be screaming bloody murder. People will have forgotten how the Gang of Eleven decided to import rice and sugar, instead of producing it locally. People will forget how when the Gang of Eleven used the Haitian army to wipe out thousands of less fortunate Haitians, when their personal and economic interests were questioned. People will forget how in 2009, people couldn't get to work, children couldn't go to school, because the Gang of Eleven didn't like the lowering of the public gas price. There were no complaints about windfall profits when the price went up, but the reversal of fortune is unacceptable to the Gang of Eleven.

Despite all of our time in the country, we at Haitian Hearts have never gotten too involved in the cultural aspects of Haiti, though I find learning about the culture interesting and Carnival sounds like a lot of fun. In theory, it's the big, indulge-all-your-desires blowout before the abstinence and penance of Lent begins on Ash Wednesday. When Haiti was a predominantly Catholic nation, this was probably more the case. But even though the religious significance may have faded, the parades, parties, bands, dancing, costumes have remained. So party on!

What's the Solution?

Sometiemes when we've been in Haiti in a clinic, the waiting room overflowing with sick and poor children, I want to scream, "Why doesn't the world do something?" Why is it that the suffering children of the world don't command our attention, our compassion, our action?

Calm-headed sages might take me aside and say, "Maria, fixing this problem just isn't so simple." How do you go about making life better for these children? To use a hospital analogy: if sick poor children are the patient it seems the disease requires both the emergency room and long term chemotherapy.

Aid from the developed world is one of the accepted solutions to developing world poverty. Well, not according to Dambisa Moyo, a Zambian-born economist with a book coming out called, Dead Aid. In this interview in the NY Times, when asked what she thinks has held back Africans, Moyo responds,

I believe it’s largely aid. You get the corruption — historically, leaders have stolen the money without penalty — and you get the dependency, which kills entrepreneurship. You also disenfranchise African citizens, because the government is beholden to foreign donors and not accountable to its people.

She believes that things like capitalism, microfinancing, small businesses are the way to change a country as she says is happening in China.

Perhaps she's right and this is a better solution. In any case, how many children will have to die before things change?

Katia Needs a Job

Katia, pictured above with my dad, had successful surgery in Joliet in 2004. She had a heart damaged by rheumatic fever. I vividly remember the autumn day that we got her U.S. visa. What a time of celebration!

After recuperating for a couple of months, Katia returned to Haiti in May 2005. We see Katia when we travel to Haiti and keep her supplied with the medicines she needs.
Katia sent John the following e-mail last week:

i got a problem, i don't work i don't go to school but you know in my country the situation isn't good but i want to make something to live; i haven't no one,then i want to ask you for seconde if you can help me in that case but i let choose for me any way you give i will accept to do it.please you know i considere you as my father. i don't feel me well cause every day i stay in my house.my mother would to help me but she can't.then please try to understand me. when you stay to do nothing that's bad please thinking about that for me please. i pray god for you for give you the possibilty.god bless you.kiss for every body.

Katia concerns embody Maslow's Hierarchy of psychological needs. Now that she has her pressing health need met, she can turn her attention to higher level needs. One of these is to be productive and contribute.

Katia's note is a good reminder that we work to restore people's health in part so that they can make their unique and necessary contribution to the world.

Walls

In the past year, my 77-year-old father Ed has been to Haiti twice. These have been his first trips to the island nation. Each time, my husband John has invited dad to help escort patients back to the States.

I must admit that I have been a little nervous about my dad going, mainly because if he were to have a health problem there would be little chance that he could get adequate care. But each trip has gone well.

There's really no substitute to going to Haiti for understanding the country. Hmm. . . understanding might not be the right word to use; perhaps encountering would be better. I have spent so much time in Haiti that I was interested in what a first time visitor's impressions were. Following are some comments John made about my dad's observations.

The first morning Ed looked at me, chuckled, and said, "We are surrounded by walls." Ed had surveyed the neighborhood that morning. And he was right. There were walls everywhere. The top of the walls that surround private homes in Haiti have broken glass and razor wire embedded in cement. One would really have to want to get inside the walls to run the risk of going over top. . .The formidable walls in our neighborhood in Haiti's capital startled him since he has spent most of his adult life trying to tear down walls.

Later that first morning in Haiti we piled into a pickup and traveled south and east of Port-au-Prince to an elite suburb called Petionville. We wanted to visit the site of La Promesse, the school that had collapsed suddenly one morning in early November. This tragedy had riveted the world's attention on Haiti and its courageous people. The UN soldiers in Haiti dug through the rubble. International disaster experts were flown in. Pope Benedict sent his condolences. The world seemed to care about these Haitian students and their families.

When we arrived at the site, a small contingent of UN forces from Jordan was walking up the street from the collapsed three story building. A big empty spot was apparent on the side of the street overlooking a steep ravine. About 30 Haitians were milling about on top of broken cement, rubble, and twisted rebar. Many were staring down into the ravine. Most people were quiet. . . I wondered about crushed little bodies that may lie just beneath my dirty shoes. One mother had lost 5 kids in the crush at the school named " The Promise".

Madame Telemak, a neighbor lady, standing in the debris with us, told me she heard a loud noise at 10 AM the morning the school fell. She ran over and witnessed the panic and screaming that enveloped the neighborhood. Family members and neighborhood people dug with their bare hands attempting to free anyone they could get to.

Walls of adjacent homes that had been attached to La Promesse were hanging in various states of disarray and shambles. The walls had been partially ripped off when the school collapsed and again with the process of extrication of survivors and victims. . .After a short time, there wasn't much more to see or talk about. Helpless doesn't describe the situation. A few pictures and collective shaking of heads, and it was time to leave. . . I agree with my sagacious father-in-law. Walls everywhere, not just in Haiti, need to be removed so places like La Promesse don't collapse and crush the future for all of us.

Host Families

Haitian Hearts could not do what it does--bring children to the States for life saving surgery--without the generous contributions of host families. Actually, "generous contributions" doesn't do these families' involvement justice. For they open their homes often for months to poor children with serious medical problems from another country who don't speak English.

As you can imagine, in addition to not feeling well, these children are often afraid and homesick. In a short plane ride, they have been transported from their familar world to one that, however more prosperous, is jarringly different and filled with strangers.

Thanks to our host families, these children are soon among friends. Our families feed, hold, play with, rock and in all ways help these children make the adjustment to the States and prepare and recover from surgery. They take them to appointments, sit by their beds, and act as their surrogate parents with as much love, caring, and effort as they do for their own children.

So many dedicated families have helped Haitian children through the years, but I'd like to mention one in this post: Jim and Jane Ebel of St. Louis. Jim is a physician and Jane is an art teacher. The Ebels, who have four grown children are a close knit family, who are devout in their faith. Jim and Jane make a good team and have provided a wonderfully loving home to children from the ages of 10 months to 17 years. Jim monitors the children's health and Jane does art projects with the kids. They take them to church, to family events, and to the sights of St. Louis, as well as everything mentioned above that goes into caring for a child who has had major surgery. Actually, this list seems woefully inadequate because what the Ebels really do is make the child part of their family.

They have done this for five children and even two of the children's mothers. Jim and Jane keep in touch with some of their guests after they return to Haiti. They have really given of themselves to these children.

I think I know Jim and Jane well enough to know that they would say that they have received as much or more as they have given. In a awesome and mysterious way, isn't this how it works?The Ebel Family is an inspiring example of the principle. We thank them and so do a lot of people in Haiti.

Heurese Update

Heurese, the young woman who had surgery a couple of months ago in Cleveland, is doing very well. She is continuing to recover in Cleveland.

Heurese had a state-of-the-art artificial heart valve put in to replace her defective valve. One of the really excellent things about this new valve is that she shouldn't have to be on blood thinners for the rest of her life.

You may know that blood sometimes clots around artificial things in the body. In order to prevent this, patients with artificial valves have to take medicine that thins the blood for the rest of their lives. For people who live in Haiti, this is problematic because they have to monitor their blood to ensure that it doesn't get too thick or thin. This can be done in Haiti, but like many things, it is extra difficult. For reasons I can't explain, Heurese's new valve will not require her to take blood thinners.

Heurese is a very industrious person. With her health restored, she is helping her host family with chores and in any way she can.

She is a blessing to all of us.

Frandy

Life is very hard for poor people in poor countries. All their energy and attention is focused on survival: getting enough food to eat, having safe shelter, obtaining clean water. It's hard for people to try to better their lives or the lives of their children in these circumstances.

Once in awhile, though, you come across a person who for many reasons, is able to think of and work toward a better life. We know such a person in 20-year-old Frandy. We met Frandy seven years ago when he came to John about his heart.

Frandy lives on top of a mountain with his mother and two older brothers in the seaside slum of Carrefour, next to Port-au-Prince. He is very thin. I remember when we went to Frandy's home. We hiked and hiked and came to a two room, concrete block structure with a tin roof. Frandy welcomed us, and his mother served us Coca Cola that they had gotten for the occasion of our visit.

Frandy had a hole in his heart, and he came to St. Louis for medical care. His mother accompanied him. On the first night here, as his mother soaked up the incredible luxuries of this country, she said, "We are in paradise."

Frandy did not have to have surgery, which was a blessing. Another blessing for him was an opportunity to experience the blessings of the United States.

He returned to Haiti after a two month stay. Frandy was already a driven person who excelled in school. He was now motivated to work even harder and with the support of people in the States, he saw a way that he might attain the almost impossible goal for a poor Haitian of going to college.

Frandy's supporters paid for his education in Haiti. He studied and studied. He listened to the Voice of America. He practiced writing English through sending e-mails and speaking English with anyone he could. He became quadralingual in the process. Frandy speaks French, Haitian Creole, English, and Spanish.

He passed the Haitian equivalent of high school, a huge achievement for someone from Frandy's background. Later this month, he will take the TOEFL (Test of English as a Foreign Language). Passing TOEFL is a requirement for a foreign student to attend college in the United States. Say a prayer that he does well, will you?

I think Frandy is succeeding because he is: intelligent and driven. These may be God-given qualities, but Frandy is making the most of them. He also has people willing to invest in him. Without this, attending college in the United States would be a cruel dream.

Frandy sees a better life for himself and his family and that vision draws him on. I admire him a lot. God willing, he will succeed.

Stop and Think Some More

I've been railing to anyone who will listen--as I'm sure many have--about the outrageous greed, arrogance, and even criminality of the corporate executives whose companies have received bailouts from us and who are using money to reward themselves with bonuses that are insane in the best of times and to buy lavishly appointed jets and outrageously expensive office furniture that doesn't even make sense. And then to justify their actions, they say things like if we don't pay these bonuses, we won't attract the best talent. The best talent?!!! You mean the talent to drive the financial system and everyone's 401K into the ground?

I remember in the 1980's when Reagen took on the welfare queens--women who were scamming the system and collecting multiple checks--regaling us with stories about a Cadillac-driving, fur wearing welfare mom. These guys from New York make her look like a piker. The sense of undeserved entitlement is mind boggling. These guys think they are playing a game--a winner's game--where there are no consequences and no matter how badly you screw up, you never lose. And in this game, we all are the bank, like in a Monopoly game, dispensing endless qualities of money whenever they want it. What kind of fantasy universe are they living in?

Apparently the same one I am and this is where this post finally relates to Haiti. For I don't want to let the above guys off the hook--they truly are criminal--but when I examine my assumptions and expectations about my standard of living as it relates to the majority of people in Haiti and other developing countries, I find my world view too similar to that of the head of Merrill Lynch. I have my comfortable, warm, water tight home, a never ending supply of food, vacations to look forward to, my own car, my own computer, and really all the books I want to buy. And the Haitians? Well, they're eating too many mud pies or not at all.

How do the terrible living conditions (to put it mildly) of the people in Haiti relate to the way I--or you--live? Well, they do, my friends, they do, even if it's as simple as that I could use more of my disposable income to buy food for people in Haiti. The more complicated, systemic reasons that the developed world's standard of living comes at the cost of those who were unfortunate to be born in poor countries is detailed in Paul Farmer's book, "The Uses of Haiti" which I will summarize in future posts.

For now, suffice to say, there is plenty of blame to go around.

Stop and Think

The picture of the above little girl is one my husband took on his most recent trip to Haiti. She lives in Carrefour, a large slum adjacent to Port-au-Prince. We have this picture hanging in our kitchen.

So one day this week, I was getting my lunch together in a hurry, kind of stuffing my face, to be brutally honest, and discontent with the offerings of our refrigerator. I turned around and my eyes caught the above picture. It stopped me in mid-chew.

How can I live my life the way I do when so many children are suffering? Why doesn't it matter more to everyone?

Painful questions with unsatisfactory answers.

Patient #136

One of the things that I'm most proud about John and Haitian Hearts for is the commitment made to patients. So despite my numbering Ronald patient #136, the fact is that he has a previous patient number also.

In 2004, Ronald and his father traveled from their home in Les Cayes to Port-au-Prince to see John because of Ronald's poor health. Ronald indeed had a heart problem, and in 2005, we brought him to the United States for heart surgery. He stayed with a wonderful family in upstate New York.

When Ronald was staying with his host family, and after consulting with Ronald's parents, this family decided they wanted to adopt Ronald. As is the case with many Haitian families, Ronald's parents were delighted that someone in the States wanted to adopt him. Life is very difficult for poor Haitian families, and the parents would love to give their children a better chance, even when it means giving them up. This is particularly true when the child has had serious health problems.

The idea of giving a child up for adoption like this is often very difficult for Americans and others from developed countries to understand. As heartbreaking and as un-ideal of a solution as it is, we would probably understand better if we spent even a day enduring what these families endure. They are doing it out of love. We need to work hard and urgently for a more just world where these kinds of Sophie's choice dilemmas don't exist.

So Ronald returned to Haiti to await the completion of the adoption paperwork. Haitian Hearts continued to keep track of Ronald so that we could monitor his heart. This ongoing contact allowed us to diagnose that his heart needed more surgery.

Thankfully, the same hospital and surgeon that first operated on Ronald are going to do the second surgery. He will once again stay with his host, soon to be adoptive, family.

Ronald's heart is very sick, so the news of his acceptance came in the nick of time. Now, we pray that the passport and visa paperwork will go quickly.

Ronald is pictured above.

Upstream and Downstream

Do you know the difference between upstream and downstream work? Sometimes they're called justice and mercy work. Upstream or justice work addresses the root causes of a problem, while downstream or mercy work concerns itself with delivering immediate help to people who need it now. It's prevention versus cure.

For example, Haitian Hearts mainly works in the downstream or mercy arena. We provide medical care to poor Haitians and bring children and young people to the United States for surgery. We respond to these emergency problems, most of which have their root in poverty. We don't more broadly address this poverty.

Some of our patients with heart problems have these problems due to rheumatic fever, a preventable disease. For rheumatic heart disease, upstream work might focus on educating doctors and people on strep throat and its treatment (penicillin) so that rheumatic fever doesn't develop. Work further upstream might be getting funds for more clinics and doctors and nurses in Haiti so that health care is more widely available.

A nun I know frequently talks to me about a friend of hers who runs an orphanage in Ecuador. This orphanage takes in mainly disabled children who have been abandoned. This seems to fall under the category of downstream or mercy work. But then it struck me: any work that benefits children must be considered upstream work, too. Children, we have so often heard, are the future. They will grow up and create the world anew. Helping children contributes to a just future, a future that is downstream for us now.

What could be better than that?