Back in the saddle at work, the poverty is wearing on me. In the house where we stay, and medical students/doctors/researchers rotate through, they say that there is an expiration date on almost everyone here. A point where you need to get out, go home, something. Usually it’s a combination of the poverty, violence, and badgering that wears you down.
Today as I took the new interns to lunch at the cafeteria I saw a lady that works in my building eating cookies while we ordered huge plates of rice. I asked her why she wasn’t having the plat de jou…She said she can’t pay for that. So I gave her the money to get that. Right, I know, Matthew is against handouts; it just got to me, this lady I work with.
Later I was walking down the hallway and I heard a yell from behind “Dokte! Dokte!” I stopped. It was a young man, very skinny. He told me he was starving and really needed food. Could I give him money to get food. I told him I didn’t really have much today, but I could give him some of the peanuts I had. I took him to my office and gave him my peanuts. Later I saw him vociferously eating them on the sidewalk. The man was quite hungry. Hungry probably isn’t the right word for that.
Friday, June 26, 2009
Tuesday, June 23, 2009
What We Did (On Tourism in Haiti)
No one wants to read a full recap of one person’s adventures; however I do think (hope) some perspective can be gained by my hitting the significant areas our recent travels. I will try to write by saying not necesarily what we did, but what we learned.
On Friday, Mandy and I got dropped off at the Port-au-Prince airport to fly to Santo Doming. Wrong airport. Someone there drove us to the other one. The confusion begins.
We boarded a 12-seater to Santo Domingo, Dominican Republic. After arriving, we made it to a bus station via taxi, then via a nice bus (air conditioned!) to Puerta Plata, Dominican. A few things to note – the DR seems like a resort compared to Haiti. The roads are so nice. The people aren’t everywhere. It was a crazy shock. I expect that shock now as I travel to the US; I wasn’t ready for it just going to the other side of the island. As one friend told me, “you live in a bad part of Africa right now; you’re going to Latin America – it’s a lot different.” He was right.
I made friends with the girl next to me on the bus. She was Haitian but studying in Dominican (Medicine). As my Spanish leaves something to be desired and her English was spotty, we actually spoke quite a bit in Creole – making me realize I know a lot more than I thought. Upon arriving to Puerta Plata, this girl and her husband actually gave Mandy and I a ride to our resort. It was very nice of them. The resort was unreal. All of the sudden we ate and drank all we wanted from Fri-Sunday. It was wonderful. We even got the chance to tear up a relatively empty dance floor late one night; I had blisters on my feet afterwards. It was an unreal break from Haiti. We kayaked and snorkeled in the ocean, and I mangad to lose several ping pong games to Mandy. Also, one night a waiter was so kind as to "get us in" to a really nice resteraunt where you needed reservsations there. I tried to give him the smooth handshake with some money for getting us in (long story as to why this was such a big deal). The money exchange went well, but instead of saying "gracias" I choked and said "por favor". Luckily Mandy was behind me speaking Spanish and telling him thank you...
We had a great time. Leaving Sunday, our plan was to head to Cap Haitian (in Haiti), to see the Citadelle, then bus down the next day to PAP (6 hour bus ride). We rode on the back of motorcycles to the actual city Puerta Plata from the resort. Then, we walked until we flagged down a bus heading to the border. We took this bus, and then took another motorcycle to the actual border. We then walked up to the border (sketchy!) and it was physically locked. We were told it was closed because of the Haitian elections. Great. We immediately were hit the reality of poor haitians all around– they follow you around in the streets, eager to “help” you. In reality, they want money. We can argue about whether this is good or bad, warranted or not, but however you split it it can be a real pain in the ass. End of story. If you think I’m being harsh, come walk the streets as a white person in Haiti. It’s probably depressing or sweet or something if you’re here for a week or two. If you live here, it’s different. Imagine if every time you walked out your front door, people came up to you. NOT to say hi or greet you, but to ask for money. It's not just asking - its badgering; constantly doing things you don't need then demanding money ("Don't run in the street....give me 10 dollar"). It's different than many poor people I've been around. As if you're the bad guy suddenly. And when you say no they follow you and keep talking. You say no several times, and they still persist. Then when you finally actually don’t give them money they pitch a fit. I digress. I did give money to a man for exchanging our money for us and money to a kid for "shining" my tennis shoes.
We made it to a hotel (can you call it this?) and slept. Not before Haitian men and children wanted our money (for walking with us to the hotel, which we told them we knew where it was…). We spent a long, hot night there. What a strange border city. The next day we pushed our way through people streaming across the border. It was market day, where the Haitians come across to sell. The border was WIDE open. It was crazy. We were stopped because we were white; otherwise our passports never would have been stamped. AS SOON as we crossed the border things got nasty. Literally as soon as we crossed. It’s just different. Run down. Poverty. Like African slums. We had to search for where to get our passport stamped. We then rode another motorcycle to find a bus. We piled in a school bus PACKED with Haitians 3-4 to a seat. Not joking. They were very nice to us though, even though we were the only whites within miles. This was actually a nice ride. At one point we saw white people. We passed missionaries at one point, builidng a building. It was weird, being on the bus looking out. I felt like I was haitian, looking at them, thinking, what a strange site, all those blan.
We eventually got off and flagged another bus to the Citadelle. Here, we rode on the back of motorcycles up a ways (this was an insane ride). Then we walked up to the great historic site: http://en.wikipedia.org/wiki/Citadelle_Laferriere
Of course, things were as “Haitian” as ever. A Haitian guy insisted on walking with us – even though I repeatedly told him I had no money for him. Mandy told him numerous times as well. (She speaks Spanish, I speak Creole; we told him in both, and English.) At the entrance he still walked with us, insising on giving us some terrible tour (e.g. “this is a cannon”…). He was bothering me and Mandy. Finally, as we walked up onto a terrace, he began saying “no no, this way”. At which point I got stern. I just yelled at him the equivalent of “look buddy, we paid the entrance price, we are going to look where we want.” He was like "fine." Then he walked over with us and I was like, "look, we didn’t ask for you, we've repeatedly told you we don’t have money for you, and now you're annoying us. Go away!" He started yelling at me how he showed us the shortcut on the walk up, etc etc. I told him, "I would pay you 50 goude for that, no more, and the smallest I have is 100, and you're not getting that. You are annoying us." So I tell him to go away. He’s yelling at me, etc. We walk down to the middle of the castle, where 4 other men are sitting. Our “guide” is still yelling, and now begins yelling at them that we stiffed him. THANK GOODNESS I know some creole. I could understand what he was saying to them. I yelled to the men in creole, “Not true, we told him we had no money for him and to leave us alone; he wouldn’t”. At this point I was a bit scared. No one else was in this castle (Seriously, no one), and you can easily “fall” off any one of these ledges. (Yes, it is the sketchiest “tourist” spot I’ve ever seen in my life). And now I’m yelling at some Haitian guy. Great. Luckily, the men sided with us and also started yelling at the other guy. Side note: it’s very hard for me to enjoy vacations like this. And you wonder why Haiti has trouble attracting tourists? Who wants to get hastled like this AND fear for their life during vacation?? At any rate, I am now scared he is going to corner us in a dark part of the castle or on a terrace and try to kill/rob us. As we descended some stairs into a small alley, he was there. He had something in his hand. My heart rate jumped a bit, although I tried to look cool, and big. He had 50 goude in his hand. “Here, you said you would give me 50 goude, so I got change”, he said. I said "of course," and traded him my 100 goude for his 50. I love Haiti perhaps more than anyone, and things like this are never going to help the economic siutation. You're sitting there reading this thinking, "I would never go do this." And for good reason. And it's a shame, the Citadelle is amazing, and this could be a real money-maker for them.
I forgot to mention that at this point I am delirious, emotionally and physically spent:
(taken from wikipedia) “The Citadel is one of the most popular tourist destinations in Haiti. Directions to and history of the fortress are provided by self-appointed guides from the town of Milot. Visitors may be asked to pay a small fee at the entrance to the Citadel. Visitors are encouraged to rent a horse for the uphill trek. The first portion of the seven-mile (11 km) trail is navigable by 4WD vehicle, although infrequent landslides and construction projects sometimes make this unreliable. From the mid-level parking lot, the second portion must be completed either on horseback or on foot. The entire seven-mile-trail starting in Milot, almost completely uphill, can be walked by experienced hikers who carry plenty of water. Most of the interior of the Citadel fortress itself is accessible to visitors, who may also climb the numerous staircases to the fortress's roof, which is free of guardrails. On a clear day, the city of Cap Haitien and the Atlantic Ocean can be seen to the north.”
The view was incredible. I was also carrying 2 L of beer from the Dominican, which I questioned the utility of every minute of the hike. And the "no guardrails" on top of this castle was truly crazy (you could easily pulmmet to your death with a wrong step). As we rode on the motorcycles back down across steep, wet cobblestone, we eventually were at the base. Here, we were deciding on how to get to Puerta Plata, at which point a black SUV, with a big, heavy set black man driving, pulls up. Tinted windows, bass bumping. The ticket office guy says, “hey, my friend will give you ride,” and points to the SUV. I walk over to the SUV. His window is rolled down and he speaks broken English. “Friend, no problem, I will give you ride. Just get in.” I got closer and realized he was drunk and was holding a martini glass just below the window. Now, I’m not the smartest guy in the world, but I was quite sure this was a bad idea. This was us about to get robbed, I am sure of that. I just kept saying no and walked off. We ran into town on foot and found a tap-tap:
http://bonsamaritan.org/yahoo_site_admin/assets/images/Bus2.19173702_std.jpg
We crammed into this and found a domestic airport. It was almost 3 pm and it would take 6 hours to bus down to Port-au-Prince, then we would have to find a way across Port-au-Prince at night up to our house. No way. We needed a flight. We walked into the airport at 2:45 and managed to catch the last flight, at 3pm, down to PAP. It just so happened that GHESKIO was picking up the summer interns in from the US at the airport at 4:30 that day. They picked us up too. We returned safely with the new summer students.
I said I would not report what we did, but rather what we learned. I did just the opposite, I fear. Regardless, I will posit a few things:
1) Tourism in Haiti sucks because it’s dangerous.
2) It really is dangerous in Haiti, no matter what someone that has been here for a month or two during a “calm” time tells you (e.g. “I was there for a few months, it’s fine!”).
3) Tourism in Haiti also sucks because people bother you. They don’t get that you want to have a nice time; you don’t want to be arguing with someone to leave you the hell alone the whole time you’re on vacation.
4) Tourism in the DR is nice because they seem to be capitalizing on what they have- warm weather, beaches, safety. Haitians could learn from this. There ARE beautiful beaches and sites in Haiti.
5) Tourism in Haiti will continue to be bad as long as there is violence and instability. Why spend vacation here, even if it were at a resort, when violence is looming?
6) Despite all of this, we breathed a sigh of relief when we made it to Port-au-Prince, perhaps the most dangerous place. But to us it's home, and it felt good to get back home, where I have friends and family around to help if something goes wrong.
7) Haiti has the resources to provide a tourism industry, if only they could:
1) provide a stable enough environment, and
2) learn to recognize what tourists want (not to be hassled the whole
time, for one).
8) If you think I am being overly harsh; feel free to come on down and back pack around the country some. I love this place and many of the people here; and I’m trying to be as true to the truth as I can regardless of how that comes out. I actually think there could be a real tourism industry here, it just needs to be guided safely and made accessible to those that don't speak Creole/know how to deal with things here.
On Friday, Mandy and I got dropped off at the Port-au-Prince airport to fly to Santo Doming. Wrong airport. Someone there drove us to the other one. The confusion begins.
We boarded a 12-seater to Santo Domingo, Dominican Republic. After arriving, we made it to a bus station via taxi, then via a nice bus (air conditioned!) to Puerta Plata, Dominican. A few things to note – the DR seems like a resort compared to Haiti. The roads are so nice. The people aren’t everywhere. It was a crazy shock. I expect that shock now as I travel to the US; I wasn’t ready for it just going to the other side of the island. As one friend told me, “you live in a bad part of Africa right now; you’re going to Latin America – it’s a lot different.” He was right.
I made friends with the girl next to me on the bus. She was Haitian but studying in Dominican (Medicine). As my Spanish leaves something to be desired and her English was spotty, we actually spoke quite a bit in Creole – making me realize I know a lot more than I thought. Upon arriving to Puerta Plata, this girl and her husband actually gave Mandy and I a ride to our resort. It was very nice of them. The resort was unreal. All of the sudden we ate and drank all we wanted from Fri-Sunday. It was wonderful. We even got the chance to tear up a relatively empty dance floor late one night; I had blisters on my feet afterwards. It was an unreal break from Haiti. We kayaked and snorkeled in the ocean, and I mangad to lose several ping pong games to Mandy. Also, one night a waiter was so kind as to "get us in" to a really nice resteraunt where you needed reservsations there. I tried to give him the smooth handshake with some money for getting us in (long story as to why this was such a big deal). The money exchange went well, but instead of saying "gracias" I choked and said "por favor". Luckily Mandy was behind me speaking Spanish and telling him thank you...
We had a great time. Leaving Sunday, our plan was to head to Cap Haitian (in Haiti), to see the Citadelle, then bus down the next day to PAP (6 hour bus ride). We rode on the back of motorcycles to the actual city Puerta Plata from the resort. Then, we walked until we flagged down a bus heading to the border. We took this bus, and then took another motorcycle to the actual border. We then walked up to the border (sketchy!) and it was physically locked. We were told it was closed because of the Haitian elections. Great. We immediately were hit the reality of poor haitians all around– they follow you around in the streets, eager to “help” you. In reality, they want money. We can argue about whether this is good or bad, warranted or not, but however you split it it can be a real pain in the ass. End of story. If you think I’m being harsh, come walk the streets as a white person in Haiti. It’s probably depressing or sweet or something if you’re here for a week or two. If you live here, it’s different. Imagine if every time you walked out your front door, people came up to you. NOT to say hi or greet you, but to ask for money. It's not just asking - its badgering; constantly doing things you don't need then demanding money ("Don't run in the street....give me 10 dollar"). It's different than many poor people I've been around. As if you're the bad guy suddenly. And when you say no they follow you and keep talking. You say no several times, and they still persist. Then when you finally actually don’t give them money they pitch a fit. I digress. I did give money to a man for exchanging our money for us and money to a kid for "shining" my tennis shoes.
We made it to a hotel (can you call it this?) and slept. Not before Haitian men and children wanted our money (for walking with us to the hotel, which we told them we knew where it was…). We spent a long, hot night there. What a strange border city. The next day we pushed our way through people streaming across the border. It was market day, where the Haitians come across to sell. The border was WIDE open. It was crazy. We were stopped because we were white; otherwise our passports never would have been stamped. AS SOON as we crossed the border things got nasty. Literally as soon as we crossed. It’s just different. Run down. Poverty. Like African slums. We had to search for where to get our passport stamped. We then rode another motorcycle to find a bus. We piled in a school bus PACKED with Haitians 3-4 to a seat. Not joking. They were very nice to us though, even though we were the only whites within miles. This was actually a nice ride. At one point we saw white people. We passed missionaries at one point, builidng a building. It was weird, being on the bus looking out. I felt like I was haitian, looking at them, thinking, what a strange site, all those blan.
We eventually got off and flagged another bus to the Citadelle. Here, we rode on the back of motorcycles up a ways (this was an insane ride). Then we walked up to the great historic site: http://en.wikipedia.org/wiki/Citadelle_Laferriere
Of course, things were as “Haitian” as ever. A Haitian guy insisted on walking with us – even though I repeatedly told him I had no money for him. Mandy told him numerous times as well. (She speaks Spanish, I speak Creole; we told him in both, and English.) At the entrance he still walked with us, insising on giving us some terrible tour (e.g. “this is a cannon”…). He was bothering me and Mandy. Finally, as we walked up onto a terrace, he began saying “no no, this way”. At which point I got stern. I just yelled at him the equivalent of “look buddy, we paid the entrance price, we are going to look where we want.” He was like "fine." Then he walked over with us and I was like, "look, we didn’t ask for you, we've repeatedly told you we don’t have money for you, and now you're annoying us. Go away!" He started yelling at me how he showed us the shortcut on the walk up, etc etc. I told him, "I would pay you 50 goude for that, no more, and the smallest I have is 100, and you're not getting that. You are annoying us." So I tell him to go away. He’s yelling at me, etc. We walk down to the middle of the castle, where 4 other men are sitting. Our “guide” is still yelling, and now begins yelling at them that we stiffed him. THANK GOODNESS I know some creole. I could understand what he was saying to them. I yelled to the men in creole, “Not true, we told him we had no money for him and to leave us alone; he wouldn’t”. At this point I was a bit scared. No one else was in this castle (Seriously, no one), and you can easily “fall” off any one of these ledges. (Yes, it is the sketchiest “tourist” spot I’ve ever seen in my life). And now I’m yelling at some Haitian guy. Great. Luckily, the men sided with us and also started yelling at the other guy. Side note: it’s very hard for me to enjoy vacations like this. And you wonder why Haiti has trouble attracting tourists? Who wants to get hastled like this AND fear for their life during vacation?? At any rate, I am now scared he is going to corner us in a dark part of the castle or on a terrace and try to kill/rob us. As we descended some stairs into a small alley, he was there. He had something in his hand. My heart rate jumped a bit, although I tried to look cool, and big. He had 50 goude in his hand. “Here, you said you would give me 50 goude, so I got change”, he said. I said "of course," and traded him my 100 goude for his 50. I love Haiti perhaps more than anyone, and things like this are never going to help the economic siutation. You're sitting there reading this thinking, "I would never go do this." And for good reason. And it's a shame, the Citadelle is amazing, and this could be a real money-maker for them.
I forgot to mention that at this point I am delirious, emotionally and physically spent:
(taken from wikipedia) “The Citadel is one of the most popular tourist destinations in Haiti. Directions to and history of the fortress are provided by self-appointed guides from the town of Milot. Visitors may be asked to pay a small fee at the entrance to the Citadel. Visitors are encouraged to rent a horse for the uphill trek. The first portion of the seven-mile (11 km) trail is navigable by 4WD vehicle, although infrequent landslides and construction projects sometimes make this unreliable. From the mid-level parking lot, the second portion must be completed either on horseback or on foot. The entire seven-mile-trail starting in Milot, almost completely uphill, can be walked by experienced hikers who carry plenty of water. Most of the interior of the Citadel fortress itself is accessible to visitors, who may also climb the numerous staircases to the fortress's roof, which is free of guardrails. On a clear day, the city of Cap Haitien and the Atlantic Ocean can be seen to the north.”
The view was incredible. I was also carrying 2 L of beer from the Dominican, which I questioned the utility of every minute of the hike. And the "no guardrails" on top of this castle was truly crazy (you could easily pulmmet to your death with a wrong step). As we rode on the motorcycles back down across steep, wet cobblestone, we eventually were at the base. Here, we were deciding on how to get to Puerta Plata, at which point a black SUV, with a big, heavy set black man driving, pulls up. Tinted windows, bass bumping. The ticket office guy says, “hey, my friend will give you ride,” and points to the SUV. I walk over to the SUV. His window is rolled down and he speaks broken English. “Friend, no problem, I will give you ride. Just get in.” I got closer and realized he was drunk and was holding a martini glass just below the window. Now, I’m not the smartest guy in the world, but I was quite sure this was a bad idea. This was us about to get robbed, I am sure of that. I just kept saying no and walked off. We ran into town on foot and found a tap-tap:
http://bonsamaritan.org/yahoo_site_admin/assets/images/Bus2.19173702_std.jpg
We crammed into this and found a domestic airport. It was almost 3 pm and it would take 6 hours to bus down to Port-au-Prince, then we would have to find a way across Port-au-Prince at night up to our house. No way. We needed a flight. We walked into the airport at 2:45 and managed to catch the last flight, at 3pm, down to PAP. It just so happened that GHESKIO was picking up the summer interns in from the US at the airport at 4:30 that day. They picked us up too. We returned safely with the new summer students.
I said I would not report what we did, but rather what we learned. I did just the opposite, I fear. Regardless, I will posit a few things:
1) Tourism in Haiti sucks because it’s dangerous.
2) It really is dangerous in Haiti, no matter what someone that has been here for a month or two during a “calm” time tells you (e.g. “I was there for a few months, it’s fine!”).
3) Tourism in Haiti also sucks because people bother you. They don’t get that you want to have a nice time; you don’t want to be arguing with someone to leave you the hell alone the whole time you’re on vacation.
4) Tourism in the DR is nice because they seem to be capitalizing on what they have- warm weather, beaches, safety. Haitians could learn from this. There ARE beautiful beaches and sites in Haiti.
5) Tourism in Haiti will continue to be bad as long as there is violence and instability. Why spend vacation here, even if it were at a resort, when violence is looming?
6) Despite all of this, we breathed a sigh of relief when we made it to Port-au-Prince, perhaps the most dangerous place. But to us it's home, and it felt good to get back home, where I have friends and family around to help if something goes wrong.
7) Haiti has the resources to provide a tourism industry, if only they could:
1) provide a stable enough environment, and
2) learn to recognize what tourists want (not to be hassled the whole
time, for one).
8) If you think I am being overly harsh; feel free to come on down and back pack around the country some. I love this place and many of the people here; and I’m trying to be as true to the truth as I can regardless of how that comes out. I actually think there could be a real tourism industry here, it just needs to be guided safely and made accessible to those that don't speak Creole/know how to deal with things here.
Thursday, June 18, 2009
A Luxury You Didn't Know You Had
The ride home went smoothly. Today at work I spoke with my friend at the Embassy and my friend that writes for the AP. Those journalists - complete nuts. He has been out there in most of these riots/protests. Impressive in a strange way. Regardless, he told me about the shooting today and where to try to avoid. Unfortunately, the clinic is in the middle of the bad parts, so we have to drive out through the chaos. The streets were charred in some parts still. Our driver carefully chose his route, looking ahead down streets, etc. The only bad part was when we got to a T in one road. To the left was a crowd around a car. Some kids were in the road waving there finger "No! No!" to cars. We turned right and eventually made our way home. The chilren waving cars off brought on a strange feeling in me. It made me think of how these children knew this violence was wrong. Very interesting. They protected us.
Also, I found out that these riots are usually orchestrated. These people get paid to cause chaos. Some do riot on their own, but many get paid.
Tomorrow we leave for the DR for the weekend. Sunday are the elections (more chaos), and Monday we return. Also, three other medical students arrive monday. As fast as this country changes there is no telling what it will be like Monday.
((Finally, in case things go bad, we are flying into Santo Domingo, then bussing up to Puerta Plata for Fri and Sat night. Then Sun we will bus over to Cap Haicen. Monday we bus back down the country side to PAP.))
There is also a young woman who works at the clinic and comes in and practices Creole with me each day now. She is beautiful. I found out today that she might be one of the girls that knew the clinic cause she was a child born with HIV here. Talking to this young woman (20), I cannot imagine the implications. Who will date her? Who will marry her? Will she try to have a child? Should she??
I also treated a woman with a yeast infection today. As I was explaining the meds, i met her son. He has Strabismus (cross-eyed). We spoke about whether he's seen a doctor, etc. I ended up giving her my phone number. This little guy broke my heart. It's a treatable and curable thing, the cross-eyes, yet probably will never be treated. It made me angry that i wasn't more powerful too. I wanted to organize an optho group to get down here...I sent a few emails, but in reality i just might not have the contacts...
Amidst the chaos the people continue to walk the streets, to sell, to bathe, to come to clinic, etc. In other words, it's nothing new here, the protests. I also heard hostility toward foreingers is growing. A frenchman was kidnapped last week. 25 US citizens were kidnapped in 2008. It hit me again today - can you imagine this is the only life you know? Can you imagine being born here, with the violence every 6 months while the world watches. And yet you carry on. As they say here, "N'ap kenbe." We're holding up.
Good night, and thanks for reading. And forget about what kind of car you own; enjoy the safety of driving home from your job and knowing you won't get mobbed or killed. It's a luxury many people don't have.
Also, I found out that these riots are usually orchestrated. These people get paid to cause chaos. Some do riot on their own, but many get paid.
Tomorrow we leave for the DR for the weekend. Sunday are the elections (more chaos), and Monday we return. Also, three other medical students arrive monday. As fast as this country changes there is no telling what it will be like Monday.
((Finally, in case things go bad, we are flying into Santo Domingo, then bussing up to Puerta Plata for Fri and Sat night. Then Sun we will bus over to Cap Haicen. Monday we bus back down the country side to PAP.))
There is also a young woman who works at the clinic and comes in and practices Creole with me each day now. She is beautiful. I found out today that she might be one of the girls that knew the clinic cause she was a child born with HIV here. Talking to this young woman (20), I cannot imagine the implications. Who will date her? Who will marry her? Will she try to have a child? Should she??
I also treated a woman with a yeast infection today. As I was explaining the meds, i met her son. He has Strabismus (cross-eyed). We spoke about whether he's seen a doctor, etc. I ended up giving her my phone number. This little guy broke my heart. It's a treatable and curable thing, the cross-eyes, yet probably will never be treated. It made me angry that i wasn't more powerful too. I wanted to organize an optho group to get down here...I sent a few emails, but in reality i just might not have the contacts...
Amidst the chaos the people continue to walk the streets, to sell, to bathe, to come to clinic, etc. In other words, it's nothing new here, the protests. I also heard hostility toward foreingers is growing. A frenchman was kidnapped last week. 25 US citizens were kidnapped in 2008. It hit me again today - can you imagine this is the only life you know? Can you imagine being born here, with the violence every 6 months while the world watches. And yet you carry on. As they say here, "N'ap kenbe." We're holding up.
Good night, and thanks for reading. And forget about what kind of car you own; enjoy the safety of driving home from your job and knowing you won't get mobbed or killed. It's a luxury many people don't have.
Escalation
I've just been told that things have escalated since yesterday, violence is in the streets. It's not clear exactly who is being targeted right now. There are rumors of shootings and kidnappings now, and I am not sure how we will get home tonight.
This I won't forget
Haiti is in the midst of a bit of unrest. There are demonstrations each day in the streets right now. This consists of mobs of people marching through the city, burning cars, etc. I had heard of these things and seen some groups as we went to and from work. The issue is that parliament passed a law increasing the minimum wage from ~2 dollars to ~5 dollars a day. To become law the president must sign it. He has not. In fact, many businesses have said that people will lose jobs if they make this law. And students have started protesting in the streets over this. They want it signed. One day we saw a car in flames. Other days we have seen cars overturned and destroyed.
Today something happened that I won’t forget. I was returning from work, in the front seat of our truck, next to our driver. I was the only “blan.” As we pulled around a corner onto a street, a kid ran in front of us, pushing a tire with a stick. To the left I made eye contact with an elderly lady, she was wagging her finger back and forth, mouthing “no” to us. It felt weird. We rounded the corner at a decent speed and immediately slammed on the brakes. In front of us was a mob overtaking the streets, running right at us with sticks and poles, yelling, angry. Our driver looked a bit panicked, cut the wheel to the left, peeled his tires, threw it in reverse, and spun around. In a matter of seconds we were turned around and peeling out in the other direction. The mob turned onto the street and was still behind us as we fled. Now, if you’ve been on the streets of PAP you know that it is CROWDED. Luckily, our driver hit the gas, weaved in and out, and we made it out of there. In fact, we drove to the clear other side of town before heading up the mountain to my place.
The whole thing felt like it was straight out of the movies. Later in the day I heard that a good friend of mine here, Jonathan Katz (who writes for the AP), was there. This same day he wrote this story:
http://www.etaiwannews.com/etn/news_content.php?id=979979&lang=eng_news
Glad it wasn’t out car.
Before you get stressed out or worried, I should point out a few things (this is for you mom). First, no one died in yesterday’s car burning, so even if we had been caught, we would have fled at worst. Second, we work at the AIDS clinic in the bad part of town- this seems bad, but everyone generally knows someone who gets their medication there and leaves those doctors alone. Third, as demonstrated yesterday, our drivers are quite good.
Tomorrow Mandy and I are flying to the Dominican Republican for some R and R. It’s probably as good a time as any to get out for a few days.
Today something happened that I won’t forget. I was returning from work, in the front seat of our truck, next to our driver. I was the only “blan.” As we pulled around a corner onto a street, a kid ran in front of us, pushing a tire with a stick. To the left I made eye contact with an elderly lady, she was wagging her finger back and forth, mouthing “no” to us. It felt weird. We rounded the corner at a decent speed and immediately slammed on the brakes. In front of us was a mob overtaking the streets, running right at us with sticks and poles, yelling, angry. Our driver looked a bit panicked, cut the wheel to the left, peeled his tires, threw it in reverse, and spun around. In a matter of seconds we were turned around and peeling out in the other direction. The mob turned onto the street and was still behind us as we fled. Now, if you’ve been on the streets of PAP you know that it is CROWDED. Luckily, our driver hit the gas, weaved in and out, and we made it out of there. In fact, we drove to the clear other side of town before heading up the mountain to my place.
The whole thing felt like it was straight out of the movies. Later in the day I heard that a good friend of mine here, Jonathan Katz (who writes for the AP), was there. This same day he wrote this story:
http://www.etaiwannews.com/etn/news_content.php?id=979979&lang=eng_news
Glad it wasn’t out car.
Before you get stressed out or worried, I should point out a few things (this is for you mom). First, no one died in yesterday’s car burning, so even if we had been caught, we would have fled at worst. Second, we work at the AIDS clinic in the bad part of town- this seems bad, but everyone generally knows someone who gets their medication there and leaves those doctors alone. Third, as demonstrated yesterday, our drivers are quite good.
Tomorrow Mandy and I are flying to the Dominican Republican for some R and R. It’s probably as good a time as any to get out for a few days.
Tuesday, June 16, 2009
Drugs
I seemed to have developed a fungal outbreak on my arm and elsewhere. So I went to the pharmacy (my ride was in a hurry), and hastily tried to get anti-fungal cream. I grabbed two bottles of different things and left. One bottle was nice ciclopirox olamine anti-fungal. Great. I looked up the other bottle: Scabies cream. Not only that, but it was lindane cream, which is a known carcinogen and has not been made/sold in the US since 1976. I am not using this cream. Despite our annoyance with drugs, at least we don’t have to worry about things like this with the FDA in place.
This weekend we went to do a hash run at a beach. We sailed over 10 miles out to an island to exercise, then came back to have drinks and food and spend the night. I will try to include pictures.
This weekend we went to do a hash run at a beach. We sailed over 10 miles out to an island to exercise, then came back to have drinks and food and spend the night. I will try to include pictures.
Friday, June 5, 2009
Mr. Blan gets the white price!
While there are no Taco Bells or anything even close to that here (obviously), there is the totally random Domino’s Pizza down the hill from us (3/4 mile). So of course, my favorite American thing to do here is to walk down to it, grab a cold beer, and eat a pepperoni pizza. As you know, when you order a pizza they type your name into the computer and it pops out on a little tab that goes on the pizza box. Well here when I get my pizza the tab on my box says “Mr. Blan” (translation: “Mr. White”). This always cracks me up. I can order, go walk around for 30 minutes, come back, and they never ask for my name…Can you imagine how awkward this would be in the states….Japanese man orders pizza and it says “Mr. Jap” on the box…I need to take a picture of this.
A few days ago we stopped to buy avocados and watermelon. From one lady I successfully got Avocados for 10 goudes each (not small avocados; this is a quarter each!). Then I went to buy a watermelon. Normally they are no less than 250 goudes, and thus we never buy one (this is 6.25!). Well, a friend at the clinic said she was able to bargain one down to 100 goudes the other day. She said it’s really hard to get them down on watermelons. She is also Haitian.
So we ran up to the corner with watermelons. I asked the lady how much. She replied 250 goudes. I told her no way and that a friend of mine just got one here for 100 goudes. She said no way and put the watermelon away.
Well, everyone knows I don’t mind being a bit of a jerk sometimes (I like to call it cordial dissent). So I started yelling, “hey, you’re giving me the white price here! My friend bought one here for 100 goudes…and she’s not white!” A few people nearby were really starting to laugh. So I just kept on her, “That’s the white price; my friend isn’t white…You give me a white price! My friend isn’t white, and it’s 100 goude for her!” People were laughing and I was just going to walk off, happy to have made my point. She came back over and was like, “fine fine, you can have it for 125 goudes.” I prob could have gotten it for 100 but I was happy to have gotten the Haitian price (perhaps cause I knew enough Creole to give her a hard time in creole?). Ha – again, imagine this in the states…too funny.
A few days ago we stopped to buy avocados and watermelon. From one lady I successfully got Avocados for 10 goudes each (not small avocados; this is a quarter each!). Then I went to buy a watermelon. Normally they are no less than 250 goudes, and thus we never buy one (this is 6.25!). Well, a friend at the clinic said she was able to bargain one down to 100 goudes the other day. She said it’s really hard to get them down on watermelons. She is also Haitian.
So we ran up to the corner with watermelons. I asked the lady how much. She replied 250 goudes. I told her no way and that a friend of mine just got one here for 100 goudes. She said no way and put the watermelon away.
Well, everyone knows I don’t mind being a bit of a jerk sometimes (I like to call it cordial dissent). So I started yelling, “hey, you’re giving me the white price here! My friend bought one here for 100 goudes…and she’s not white!” A few people nearby were really starting to laugh. So I just kept on her, “That’s the white price; my friend isn’t white…You give me a white price! My friend isn’t white, and it’s 100 goude for her!” People were laughing and I was just going to walk off, happy to have made my point. She came back over and was like, “fine fine, you can have it for 125 goudes.” I prob could have gotten it for 100 but I was happy to have gotten the Haitian price (perhaps cause I knew enough Creole to give her a hard time in creole?). Ha – again, imagine this in the states…too funny.
Wednesday, June 3, 2009
HIV Crime
Today we had a criminal in our clinic. We treated her as well as we could and let her go.
She is an HIV positive patient, as all of the patients I am seeing for study I am involved in are. I did a pregnancy test for her – she was pregnant. The OB doctor then spoke with at length. Turns out she has a boyfriend of two years that she lives with. She has HIV and knows it. Her boyfriend has no idea she has it, nor does she plan on ever telling him. In the US this is criminal behavior:
http://www.thebody.com/hivmonth/thismonth1007.html
I was fired up about clinic after seeing her. I spoke “through” the OB doc about how he would need to know as she had the child because the child was going to need very special treatment. It would be a full effort to see to it that the risk for transmission to the child was as low as possible, which would entail a few drug cocktails for the child. And despite most births in Haiti taking place outside the hospital, this one needed to be in the hospital for the child’s sake. I asked the OB doc to explain to her how important this is for her child – if she wants the best for her child. It was sad. And interesting.
One interesting question that came out of this is how this plays out legally. You will only get prosecuted if you knowingly gave someone HIV. This means you have to be tested. Thus, we now have an incentive for people to NOT get tested, especially if they are engaging in high-risk behavior as part of their job (sex workers).
If nothing else this made me interested in clinic again…This presented as a challenge. And what should the law be? Hard to say.
She is an HIV positive patient, as all of the patients I am seeing for study I am involved in are. I did a pregnancy test for her – she was pregnant. The OB doctor then spoke with at length. Turns out she has a boyfriend of two years that she lives with. She has HIV and knows it. Her boyfriend has no idea she has it, nor does she plan on ever telling him. In the US this is criminal behavior:
http://www.thebody.com/hivmonth/thismonth1007.html
I was fired up about clinic after seeing her. I spoke “through” the OB doc about how he would need to know as she had the child because the child was going to need very special treatment. It would be a full effort to see to it that the risk for transmission to the child was as low as possible, which would entail a few drug cocktails for the child. And despite most births in Haiti taking place outside the hospital, this one needed to be in the hospital for the child’s sake. I asked the OB doc to explain to her how important this is for her child – if she wants the best for her child. It was sad. And interesting.
One interesting question that came out of this is how this plays out legally. You will only get prosecuted if you knowingly gave someone HIV. This means you have to be tested. Thus, we now have an incentive for people to NOT get tested, especially if they are engaging in high-risk behavior as part of their job (sex workers).
If nothing else this made me interested in clinic again…This presented as a challenge. And what should the law be? Hard to say.
Tuesday, June 2, 2009
PETA (Letter to Time, 2008)
In light of their recent terrorist activity against some of our best scientists (e.g. The Animal Research War, by Drs. P. Michael Conn and James V. Parker), I am quite disappointed that you would allow such a forum for Ingrid Newkirk, president of PETA. Contrary to what most uneducated people think, the views of PETA are quite unusual and extremely harmful. For example, on their webpage one can easily find them pushing to end all animal experimentation. In fact, they say "...animals differ from humans significantly, making animal drug tests unreliable and dangerous...computer models, cell cultures, and human studies are more accurate." Not only is this inaccurate in many ways (computer models and cell cultures are far less accurate in many ways ), it is also dangerous. Furthermore, scientists use those techniques and only use animal models to answer those questions (and safety concerns) that other models cannot.
PETA has not only been involved in terrorizing our top scientists, but their agenda is nonsensical. In the push for no animal experimentation, they forget that: 1) institutions are already in place that make sure experimentation is rigorously regulated and serves great purpose, 2) while we know different animals are different from humans in different ways, they come much closer than cells in a dish! Who among us would like to be first in line for a drug that has never been tested in a living mammal? 3) the Nuremberg Code (drawn up after the atrocities of WWII) and the Declaration of Helsinki both declare that human experiments should be based on animal experimentation, and 4) all major medical treatments can be traced back to understanding gained from animal models.
I would assume that PETA members and supporters already know this and thus practice what they preach by declining all Medicine and Western Medical Procedures, which are all with us today because of animal experimentation. As an animal lover and animal researcher, I can tell you that I would rather discover how muscular dystrophy works in a canine model so that my son never has to experience it himself. Ingrid Newkirk herself has said that if animal research led to a cure for AIDs she would not be for it. She has championed a movement (PETA) that has now unleashed terrorist attacks against scientists who have devoted their lives to curing diseases.
I suggest that if Ingrid Newkirk truly feels the way she espouses, that humans are granted no special rights from other mammals, then perhaps she should do the following:
1) explain to our top scientists exactly how to cure diseases without animal models,
2) offer herself as a test subject for new medical treatment that has been tested in cell cultures and computer models but NOT in living animals, and
3) deny any medical treatment that is offered to her, as it is the result of decades of animal experimentation.
I have found in my career that like most things, people think they support PETA only until they are educated about how it all works. All of us are in favor of minimizing suffering in animals. It's just some of us believe that our children and loved ones are more important than other mammals. Unfortunately, it usually takes having a loved one fall very ill for this reality to set in.
TIME, I hope you merely didn't understand what Ms. Newkirk stood for when you featured her. If you did, then shame on you.I would love to write more, but I have to go feed my cats.
PETA has not only been involved in terrorizing our top scientists, but their agenda is nonsensical. In the push for no animal experimentation, they forget that: 1) institutions are already in place that make sure experimentation is rigorously regulated and serves great purpose, 2) while we know different animals are different from humans in different ways, they come much closer than cells in a dish! Who among us would like to be first in line for a drug that has never been tested in a living mammal? 3) the Nuremberg Code (drawn up after the atrocities of WWII) and the Declaration of Helsinki both declare that human experiments should be based on animal experimentation, and 4) all major medical treatments can be traced back to understanding gained from animal models.
I would assume that PETA members and supporters already know this and thus practice what they preach by declining all Medicine and Western Medical Procedures, which are all with us today because of animal experimentation. As an animal lover and animal researcher, I can tell you that I would rather discover how muscular dystrophy works in a canine model so that my son never has to experience it himself. Ingrid Newkirk herself has said that if animal research led to a cure for AIDs she would not be for it. She has championed a movement (PETA) that has now unleashed terrorist attacks against scientists who have devoted their lives to curing diseases.
I suggest that if Ingrid Newkirk truly feels the way she espouses, that humans are granted no special rights from other mammals, then perhaps she should do the following:
1) explain to our top scientists exactly how to cure diseases without animal models,
2) offer herself as a test subject for new medical treatment that has been tested in cell cultures and computer models but NOT in living animals, and
3) deny any medical treatment that is offered to her, as it is the result of decades of animal experimentation.
I have found in my career that like most things, people think they support PETA only until they are educated about how it all works. All of us are in favor of minimizing suffering in animals. It's just some of us believe that our children and loved ones are more important than other mammals. Unfortunately, it usually takes having a loved one fall very ill for this reality to set in.
TIME, I hope you merely didn't understand what Ms. Newkirk stood for when you featured her. If you did, then shame on you.I would love to write more, but I have to go feed my cats.
Prayer Study (Letter to Time, 2006)
As someone who regularly looks forward to when TIME takes research I have read in medical journals and translates it into language the layperson can understand, I was quite disappointed with the recent article “The Year in Medicine from A to Z” [Dec. 4]. I regularly encourage my college Wellness students to read TIME because of the unbiased, cogent medical and health advice that is regularly reported. However, your recent article that mentions the study of 1,802 coronary-bypass graft (CABG) patients who either received prayer (and did or did not know it) or did not receive prayer and their concomitant post-operative complications seemed to offer a bit of scientific soft-pedaling. First, you mention (as does the study) as a limitation that the investigators could not control whether friends and family prayed for these patients; and the investigators did not try to control this (unethical as well as impossible). The researchers mention this because if all subjects received robust amounts of ‘personal’ prayer, then the gain from additional prayer would in fact be harder to statistically detect. However, whether the prayers were heartfelt (because they were “provided by clergy and identical”) seems a moot point – is the Lord’s Prayer that is recited in these very Churches every Sunday any less heartfelt because it is “provided by clergy and identical”? Furthermore, if Christians are having a hard time offering ‘heartfelt’ prayers for patients recovering from open-heart surgery, then I cannot help but wonder how ‘heartfelt’ prayers can be about less life-threatening matters. I was most appalled, however, by the concluding statement of TIME that “the possible confounding factors in this study made it extraordinarily limited.” I am a bit confused as to how this study is “extraordinarily limited” compared to any other study that must control for extraneous variables. Would it have been better to let subjects ad-lib their own prayers? (Limitations then become: What was said during prayer could have accounted for the differences.) The investigators designed a well-designed study to test the efficacy of intercessory prayer for unknown individuals and should not have to soft-pedal the results any more than TIME should when reporting them. As a scientist who grew up in the Church, I am appalled to continually see Americans reject data in favor of their interpretation of whatever Holy book they adhere to, be it the Qur’an, the Torah, or the Bible. Perhaps the TIME writers were persuaded by the closing paragraph of these investigators’ paper, which does its own soft-pedaling of its results. I would hope that the TIME staff and every reader would be smart enough to read the fine print on the first page of the original article: “sponsored by the John Templeton Foundation.” John Templeton, the founder and philanthropist behind the John Templeton Foundation, is quoted on their website as saying “love and prayer” are “the most powerful weapons on earth.” While I should not expect all readers to find and examine original research for themselves (although I encourage this), I do expect TIME to adequately research any data before labeling it “extraordinarily limited.” Is this research scenario so different than my telling a relative across the U.S. that my church, despite not knowing him, is praying for him daily?
Research vs. Clinic
It is with great shame that I return to my blog. The past three weeks have held so much, from frantically pulling all-nighters and analyzing data to traveling to Seattle to present those data to trying to take over a project in Haiti where I must see patients.
This has been chalk-full of strange experiences, not limited to my absolutely splendid time in Seattle. The city itself did not seem like much special to me, but how nice it was to be back amongst researchers! It was so nice to try to keep up with all the ideas and research being presented. All the "top minds" of what my research centered on (oxygen uptake kinetics of skeletal muscle) were there, and many of the major talks centered around that area. It was invigorating. So invigorating that it has me worried about med school. Worried because I am "becoming" an expert in research and a specific research area, only to put it on hold and get clinical training. The problem with that is that I haven't enjoyed the clinical part of my days in Haiti all that much. It's too much like work that a monkey could do. No real problem solving. Just doing what's called for in a clinical situation. If symptom X, give drug Y. I miss being in the lab, generating ideas, arguing about what some strange signal means. I miss discovery. I could be doing a post-doc in a top lab in the world, and instead I am going back to school. I could also be going to school in San Diego, where one of the best physiology departments in the world is, but I am not. In the end, this is probably the right move. It’s just hard. I wanted to go to med school for several reasons, not the least among them to study cancer and work with cancer patients. Last night as I was beating myself up over this, I stumbled upon an article on lactate metabolism in cancer. It was very intriguing. As you probably know if you’re reading this, my two areas as of now are Lactate Metabolism and VO2 on-kinetics. If I did a post-doc or went to San Diego, I would be working on straight physiology, not combining my areas with cancer. As it is, I will be bringing a completely unique viewpoint to studying cancer. This feels like a huge gamble right now, but I think it’s correct (I hope it's correct). In the meantime, I am hoping to continue with my love of physiology, collaborating for experiments when possible, presenting at physiology meetings, etc. I find myself up at all hours of the night thinking and analyzing our data and just trying to “get through” the days in the clinic. This work is completely fascinating. Hopefully my gamble will pay off.
Also, in digging out old data I found a few old writings I will post here. Comments always welcomed!
This has been chalk-full of strange experiences, not limited to my absolutely splendid time in Seattle. The city itself did not seem like much special to me, but how nice it was to be back amongst researchers! It was so nice to try to keep up with all the ideas and research being presented. All the "top minds" of what my research centered on (oxygen uptake kinetics of skeletal muscle) were there, and many of the major talks centered around that area. It was invigorating. So invigorating that it has me worried about med school. Worried because I am "becoming" an expert in research and a specific research area, only to put it on hold and get clinical training. The problem with that is that I haven't enjoyed the clinical part of my days in Haiti all that much. It's too much like work that a monkey could do. No real problem solving. Just doing what's called for in a clinical situation. If symptom X, give drug Y. I miss being in the lab, generating ideas, arguing about what some strange signal means. I miss discovery. I could be doing a post-doc in a top lab in the world, and instead I am going back to school. I could also be going to school in San Diego, where one of the best physiology departments in the world is, but I am not. In the end, this is probably the right move. It’s just hard. I wanted to go to med school for several reasons, not the least among them to study cancer and work with cancer patients. Last night as I was beating myself up over this, I stumbled upon an article on lactate metabolism in cancer. It was very intriguing. As you probably know if you’re reading this, my two areas as of now are Lactate Metabolism and VO2 on-kinetics. If I did a post-doc or went to San Diego, I would be working on straight physiology, not combining my areas with cancer. As it is, I will be bringing a completely unique viewpoint to studying cancer. This feels like a huge gamble right now, but I think it’s correct (I hope it's correct). In the meantime, I am hoping to continue with my love of physiology, collaborating for experiments when possible, presenting at physiology meetings, etc. I find myself up at all hours of the night thinking and analyzing our data and just trying to “get through” the days in the clinic. This work is completely fascinating. Hopefully my gamble will pay off.
Also, in digging out old data I found a few old writings I will post here. Comments always welcomed!
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