The “Epiphany 5” returned to Boston Sunday pm 10 April with all of us in good health, a little fatigued but all energized by our mission experience.
SUMMARY: We provided medical care and medications for over 500 Haitian patients - many mothers, babies and children as well as elderly patients. We used much of the 500 pounds of meds and materials which we brought, and drew other items from the well-stocked guest house pharmacy. We left our unused meds for future mission groups.
We set up clinics in four different villages outside Leogane, which gave us a chance to explore Haiti en route to each village. Mary Provo suggested the Haitian riverbed trip in the Daihatsu truck would be a remarkable Disney attraction! Susan Almquist made her debut as a videographer with her digital camera as we travelled through the transport hub on the edge of Leogane. She might share a clip of the swarming chaos with motos, trucks and buses doing a daring ballet on the roadway!
We thoroughly enjoyed our home in Haiti, the guest house at L’Hôpital de Ste Croix’s [HSC] which is FABULOUS... OK, it may have 1950s décor (at least for now), cold (or lukewarm) showers, mosquito nets over the single hospital beds.... BUT the guest house is more than ‘a clean, well-lighted place’ as it offers great organization, security, wi-fi, and wonderful dinners from the local house cooks. The guest house is managed by volunteers. Dr. Bob Sloane and his wife Robin of Fort Worth handed the keys over to current director David Paige of Arizona only 8 days ago, and we learned a great deal from both the Sloanes and Mr. Paige.
The guest house optimized our “time on the ground” with food, shelter and transport – and was a fabulous value at $50 a night. Alas, it is shutting down for hospital renovation over the next seven weeks, so the staff of five fabulous cooks will be reduced, the team of translators may be out of work with no medical missions, the three skilled drivers may not be so busy.
We nested our suitcases in suitcases for the return trip and headed back along the lumpy, long and winding road to Port Au Prince. We found the departure process at the airport straightforward (even with three scans of our luggage and carry-ons!) as we awaited the flight north in a modern air conditioned terminal.
"Be the change you want to see in the world" said Mahatma [Great Soul] Ghandi. That was a mantra at the Harvard School of Public Health when Linda got her MPH a decade ago. We hope that we have made a contribution to that positive change and have left Haiti in a bit better shape to move forward.
With deep appreciation for everyone’s support, prayers and pills -
- Nick, Linda, Susie, Mary, and John
Wednesday, April 13, 2011
Saturday, April 9, 2011
April 8, 2011
I believe they bring us to this place so that we cannot resist coming back. It was set in the Pelerin (Pilgrim) church in a most beautiful village of Banyette, again with the walls fallen down (only adding to the beauty) but as Nick says the ‘bones’ were still intact. There was a beautifully carved podium on a slightly broken up marble raised area where we set up our field pharmacy.
We could see beautiful greening hills just above the still present door through the fallen down walls. A donkey brayed nearby off and on, and we had a dear little angel following us around all day. We had our biggest day for patients and this humble volunteer truly enjoyed triaging the people from 3 months to 95. The road in passed abundant and greening farms, much new construction and well organized rubble piles. A truly hopeful place.
PROPERTY co-chair’s view, by Nick:
And I thought we had problems at Epiphany: a lovely church set high on a hilltop with a school to the right. A nave that soared to at least 30 feet…. But the front wall, to the narthex was broken somewhat and inclined out about 10 degrees (“Cuozzo, don’t lean on that wall!) while the back wall, at the altar side of the church and tumbled completely down the hill. Our field pharmacy set up on the epistle side of the altar, like a MASH in France in one of the big ones.
Nice people, a few of which left me in tears after they thanked us for coming. Our last patient, a grizzled father of three with six grandkids hobbled over with his walking stick, had so many needs and therefore a lot of meds so we gave him a carrying bag. He smiled, shook our hands, and said ‘God bless you.” The dust, the heat, the hammering of the tropical sun faded in this moment of one to one appreciation.
-Susi
We could see beautiful greening hills just above the still present door through the fallen down walls. A donkey brayed nearby off and on, and we had a dear little angel following us around all day. We had our biggest day for patients and this humble volunteer truly enjoyed triaging the people from 3 months to 95. The road in passed abundant and greening farms, much new construction and well organized rubble piles. A truly hopeful place. PROPERTY co-chair’s view, by Nick:
And I thought we had problems at Epiphany: a lovely church set high on a hilltop with a school to the right. A nave that soared to at least 30 feet…. But the front wall, to the narthex was broken somewhat and inclined out about 10 degrees (“Cuozzo, don’t lean on that wall!) while the back wall, at the altar side of the church and tumbled completely down the hill. Our field pharmacy set up on the epistle side of the altar, like a MASH in France in one of the big ones.
Nice people, a few of which left me in tears after they thanked us for coming. Our last patient, a grizzled father of three with six grandkids hobbled over with his walking stick, had so many needs and therefore a lot of meds so we gave him a carrying bag. He smiled, shook our hands, and said ‘God bless you.” The dust, the heat, the hammering of the tropical sun faded in this moment of one to one appreciation.-Susi
Thursday, April 7, 2011
April 6, 2011
We had the EASIEST commute today to the commune of DeBoucher… and by sunset, we have served to date over 300 patients this week. 
Today our team set up in a nice house, with two medical stations and one dental station in the living room and dining room area, and the pharmacy out on the covered but cooler porch. First, a few observations on our mobile medical clinics: 
A. The Haitian colleagues on our team have vastly improved our effectiveness, efficiency and reach. We hired a Haitian doctor and nurse before we arrived and a Haitian dentist on arrival to supplement the efforts of the Epiphany 5. We also engaged five young translators who have bridged the language gap, but are also very eager and helpful in moving our hundreds of pounds of medications each day, counting pills, assisting with intake and advising patients on treatment instructions.
B.Our physician, Dr. Alex LeBrun, came out from PAP and stays with us at l’Hopital Ste Croix (HSC). We do consults in the field and compare notes over the dinner table in a mélange of French, English and Creole. He has taught us a great deal about tropical medicine.C.Our dentist, Dr. Emmanuel Bastien, has proved a real hero as perhaps 20% of our patients come with painful dental problems. He does yeoman’s duty with tooth extractions. Typical Rx was Ibuprofen for the pain and Amoxicillin to control infection. As David Paige, the manager at HSC, observed: a dentist provides immediate relief to people in pain.
D. Our nurse, Rosaline Telfort, is immensely efficient in triage. A woman of few words, she shows compassion as well as speed in assessing patients.E. Our PoE nurse, Susan Almquist, also worked in triage but became a star in the pharmacy, especially as queen of pediatric suspensions. She explained how pain killer or antibiotics are best delivered to pediatric patients. Whether working in triage or the pharmacy, Susan, Mary, John and Nick have become more closely engaged with patients and received many expressions of gratitude.
F.iPhone on scene: here we were on ‘the dark side of the moon’ for cell phone bars, but Linda added ePocrates as a PDR on a PDA (with help from our son Alex) on the advice of Dr Emily Hitron, a Haiti veteran from Needham. Linda found that program highly effective for prescribing med dosages for infants and kids, since she usually cares for adults in Boston.G. We typically carry four large suitcases of medications to each clinic. Deciding which medications to include and making certain that we have enough medications is the daily dilemma. Linda created the Formulary, the menu of drugs for the pharmacy, and filled it with an order from Blessings International and all the great donations. We carried the medications to Haiti in 10 suitcases, each weighing nearly 50 lbs.
H.Pharmacy operations: filling the RX proved to be the bottleneck and by Day 3 we had more pre-packaged RXs, a better alpha storage of our formulary, and we had a better industrial system for picking and packing orders. A typical Rx for each per person has vitamins, Tylenol or Advil, and two items for a specific problem. Several Rx had as many as 6 or 7 items. John, Mary, Nick and Susan work the apotheke – and have a new respect for the profession! By Day 3 we used bins for each order and specialization to speed up delivery. The climate with 90 degree heat gives ‘sweat equity’ a new dimension for working or just standing, sitting in line. And we were just trying to ensure the right…
-Medication
-Dosage
-Form (pill or suspension)
-Count
One comment on what is valued here: our empty large pill containers are prized for storage of salt, sugar or other items at home. At one clinic a mom was as thrilled with a set of our big Vitamin bottles with screw tops as with fine china.
EN FIN: With Mickey as Haiti’s new president, everyone seems more optimistic today.
SUMMARY: we do think we are leaving this a healthier place and felt the warmth of the Haitian people today
-Nick & Linda
April 5, 2011
Another day of pure adventure we gathered our troops and headed to Laberger, with a warning from our guest house director David to head back ASAP if it starts to rain. 
The excitement began as we drove through sugar cane and banana plantations, then entered and drove for over a mile in a mostly dry river bed. We had never commuted to work in a wet river bed before… and David from Arizona understood how an arroyo becomes dangerous with flood waters.
Suddenly, two small boys came running over from where their mother was on the river bank. Banging on the side of our truck, they told our driver we had missed Exit 27-B, "the safe road" to Laberger.[ Signaling the lead truck, we turned and found a gentle slope from which to climb from the river bed. Crossing a field, we next faced a narrow path, traveled only by foot and, perhaps, by a very occasional "moto" (small motor bike).
Our drivers skillfully maneuvered this incredibly difficult terrain and we finally broke through the wooded area into a clearing, surrounded by unbelievably beautiful hills and distant views. We parked, unloaded our five large duffels and suitcases, then trecked up about 150 feet on a 45 degree path to a shaded area where, awaiting us was a number of hand-hewn tables, covered with table cloths.
We met the most delightful people and treated over 100, some 17 of whom needed dental work from Dr. Emmanuel, a most compassionate and skilled dentist, well-beloved by the locals. About 1:00 pm it started to rain. With dozens of people yet to see and prescriptions to fill, silently, we all prayed that the clouds would pass and the rain hold off. Another prayer answered as the clouds suddenly lifted and the sun returned!
At the top of the ridge just a few feet above our medical camp on the foundations of ruined buildings was a spectacular vista that looked over ‘mountains beyond mountains.’
Breaking camp at 5:02 p.m. we mounted our vehicles, only to find that the large truck battery had died. It was locked in a cage and it took a while to find the key. Making some adjustments - no luck! Fortunately because we were on a hillside, the men pushed the truck and after its washboard descent on the wavy terrain, it fired up and we were on our way home, tired, hot, but elated at the wonderful experience.
-Mary Provo
The excitement began as we drove through sugar cane and banana plantations, then entered and drove for over a mile in a mostly dry river bed. We had never commuted to work in a wet river bed before… and David from Arizona understood how an arroyo becomes dangerous with flood waters. 
Suddenly, two small boys came running over from where their mother was on the river bank. Banging on the side of our truck, they told our driver we had missed Exit 27-B, "the safe road" to Laberger.[ Signaling the lead truck, we turned and found a gentle slope from which to climb from the river bed. Crossing a field, we next faced a narrow path, traveled only by foot and, perhaps, by a very occasional "moto" (small motor bike).
Our drivers skillfully maneuvered this incredibly difficult terrain and we finally broke through the wooded area into a clearing, surrounded by unbelievably beautiful hills and distant views. We parked, unloaded our five large duffels and suitcases, then trecked up about 150 feet on a 45 degree path to a shaded area where, awaiting us was a number of hand-hewn tables, covered with table cloths. We met the most delightful people and treated over 100, some 17 of whom needed dental work from Dr. Emmanuel, a most compassionate and skilled dentist, well-beloved by the locals. About 1:00 pm it started to rain. With dozens of people yet to see and prescriptions to fill, silently, we all prayed that the clouds would pass and the rain hold off. Another prayer answered as the clouds suddenly lifted and the sun returned!
At the top of the ridge just a few feet above our medical camp on the foundations of ruined buildings was a spectacular vista that looked over ‘mountains beyond mountains.’
Breaking camp at 5:02 p.m. we mounted our vehicles, only to find that the large truck battery had died. It was locked in a cage and it took a while to find the key. Making some adjustments - no luck! Fortunately because we were on a hillside, the men pushed the truck and after its washboard descent on the wavy terrain, it fired up and we were on our way home, tired, hot, but elated at the wonderful experience.-Mary Provo
Tuesday, April 5, 2011
April 4, 2011
Up at 6:15 AM to finish putting together medications for breakfast and an 8:00 AM start but one thing you quickly learn in Haiti is to be flexible. For reasons that none of us ever understood our trip to Orangie was not going to happen. The brand new director David Paige and marvelous Mario (more on him later) sprang into action and found us a new village. Maybe caution because of the anticipated announcement of the new president? Who knows? Anyway, they found us a new village, and in spite of a bit of a late start we were there in short order.
So let me tell you about our Mario. In spite of the fact that he goes back down stairs to the hospital to sleep because he has still not checked out because of a significant surgery last Thursday he has spent a great deal of the last two days helping David on his first day to get us going. He does it all telling stories and laughing all the time. An example of the Haitian gentle but indomitable spirit.
Spilling out of the trucks with our extraordinary interpreters and our Haitian dentist, doctor and nurse we were set up in no time. Our interpreters really know how to set up the space and manage our visitors. We were in a sort of town hall, without walls (they had fallen down, presumably in the earthquake) and benches mostly for holding everything we needed. We mentioned needing a table and low and behold soon one of our interpreters came in carrying the top of a table, still covered with a table cloth, with a village woman trailing behind with the base.We quickly got to work and I’m trying to remember if I ever sat down. I must have, to eat my lunch our incredible cooks sent with us. (More about that later too.) Back to our day; In spite of a late start and a need quite on time so our wonderful help can get back to their families we did see 110 people today. .
We had to do some quick thinking to have enough medication formulated for infants as there were more than we had expected, but it all worked out, and we didn’t have to send any one away. The people, from infant to seniors all were patient and so beautiful. Our interpreters assure us, we will get faster
I’m not sure I should tell you how wonderful the food is here at L’ Hopital Ste. Croix. But then, we do want you all to think that this is something we might want to do again with more of you so I will plunge in. I believe our head cook Jeanine could start her own restaurant. Sautéed water crest surrounded with tomatoes is one her specialties. Last night she and her crew prepared a banquet for the Slones’ going away that made me wish I could import them for my daughter’s (hoped for) wedding. Robin Slone tells us that they take care of the quest house like it is their family. Remarkably, it’s one of the staples here.Well, we are now sorting pills, thinking through the day and doing a bit of praying so I will sign off to do my share.
Susan (here, Susi)
Monday, April 4, 2011
April 3, 2011
Back on Standard Time (Haiti doesn’t observe Daylight Savings Time), our “Amazing Grace” Sunday began with an early Breakfast and the 7:00 A.M. French language worship in the former basketball court of Ste. Croix Episcopal Church in Leogane. For those of you who’ve been to El Hogar, it was akin to the assembly area, tin roof and open walls, amid a grove of mango and coconut trees that offered much-welcomed shade from the hot Caribbean morning sun. Some 50 yards away lay the skeletal remains of the former Sanctuary, crumbling concrete and bare steel reinforcing rods, with only the sacristy remaining intact. The singing was awesome, with some five choirs and groups each blending in melodious harmony. What a thrill for us when Amazing Grace was sung in French and we so easily joined in following in the hymnals. The Rev. Kerwin Delicat gave a tremendous homily, frequently citing a wide range of Biblical passages, quizzing the congregation, and getting responses from many that were right on target! I wouldn’t want to challenge our Haitian brothers and sisters to a bible trivia contest!
Most amazing is the incredible spirit and joyous love shared by the smiling people raising loud voices in prayer and song. Dr. Linda and I met briefly with Father Kerwin after the service ended at 10:15 A.M.- yes, over 3 hours after it began! He told us of the many needs the church and its school faced. Most parishioners suffered a near total loss of home, work and possessions from the January 2010 earthquake and now live in tents with Hurricane Season only eight weeks away; 20 lost their lives. As a result, parents cannot meet the tuition payments for their children at the Ste. Croix Episcopal School, so the teachers aren’t paid on time. Yet, Fr. Kerwin recognizes the crucial need to continue educating the students: “If I say they must pay, they will stop coming” and the staff and students continue on.
Here is revealed in living flesh the real mystery of the Christian faith, expressed so freely and beautifully in the spirit of love and joy. Here, the love of God and love from God keeps hope alive!
-John
Most amazing is the incredible spirit and joyous love shared by the smiling people raising loud voices in prayer and song. Dr. Linda and I met briefly with Father Kerwin after the service ended at 10:15 A.M.- yes, over 3 hours after it began! He told us of the many needs the church and its school faced. Most parishioners suffered a near total loss of home, work and possessions from the January 2010 earthquake and now live in tents with Hurricane Season only eight weeks away; 20 lost their lives. As a result, parents cannot meet the tuition payments for their children at the Ste. Croix Episcopal School, so the teachers aren’t paid on time. Yet, Fr. Kerwin recognizes the crucial need to continue educating the students: “If I say they must pay, they will stop coming” and the staff and students continue on.
Here is revealed in living flesh the real mystery of the Christian faith, expressed so freely and beautifully in the spirit of love and joy. Here, the love of God and love from God keeps hope alive!
-John
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