Monday, November 15, 2010

Dr. Herby leads a practice session

This was my final day in Haiti. We trained an excellent group of Friends today and had just the right number so that they could work comprehensively in small groups with their facilitators. We were in a horrific camp in Port au Prince. We were first directed to a tent that was full of garbage and had no seating and started looking around for another place. The Camp manager directed us to the basement of the old city theatre that sat in the middle of the camp. The earthquake had split it down the middle, and it still looked like it was in a somewhat precarious position. The basement area looked safer than the patio area, but it had a stench and such a thick layer of dust and grime that the nurses and Steve all started having allergic reactions - itching and respiratory. The Friends didn't seem to be bothered at all, probably used to it more being camp residents. We powered our way through the didactic part and then did the practices out on the patio amongst rubble and rebars and a huge crumbling column over us. We went back and forth trying to choose our poison. The Friends were remarkably enthralled by the work. At first they talked about just needing more cash to give to their older people so they would have food, but they finally agreed that they had something incredibly important to give them in helping them stabilize themselves from trauma upon trauma. They were receptive and hungry to do their own work and grateful that we were there for their own care. They made a good first pass on the skills and want more training soon. One woman was struggling with heart palpitations, agitation, and anxiety that were re-activated by her fear of Hurricane Tomas last week. In the trauma work, I helped her focus on the sensations in her body when she remembered a day in May when a clean water source finally arrived at the camp she had just migrated to--specifically, sensations of the cool water running through her when she could finally drink, and feeling the water on her hands as she was able to wash her clothes and her dishes. Working with this resource helped her neutralize the activation of fear that a tree would crush her tent in hurricane winds, and her body settled to a calmer, more balanced state.. Help coming is the only hope for these most vulnerable people.
The HelpAge model here in Haiti has been such a palpable lifeline for older people here who have lost everything in the earthquake- their homes, their livelihood, sometimes their spouse or a child. And now they are in IDP camps often with no family around or a grandchild or two that is solely in their care, a leaky tent, noise and violence everywhere. And what I heard from the Friends over and over was that older people in the camps rely on HelpAge being there , for help getting clean water, for intermittent cash for food, for microcredit grants to start a small business back, for respite out of the oppression in the camps on monthly field trips out to the beach or mountains, for education about what to do to prevent cholera and what to do if they get cholera symptoms. The Friends visit their each of their 20 plus older people beneficiaries often twice a day, assisting with personal care when needed, giving them the latest information about security and health issues, and being a support. Now almost 100 of the 200 Friends have been trained in a trauma model which promotes psychological resiliency and they have more to give themselves and their people. And the Friends have a means of usefulness and livelihood as they themselves are getting back on their feet with the part time salary HelpAge pays them. They get to be a healing asset for their country. This HelpAge structure made it possible for many people to be reached. I am amazed and inspired to see what American dollars from AARP and HelpAge International can buy. It is quite stunning.
So off to bed and to catch an early plane out in the morning, very tired after a long couple of weeks, but so honored and privileged to be a part of all this.

Sunday, November 14, 2010

Juliette, my interpreter, was the best ever
Sunday with the nurses

Just finished a good day with the nurses for them to do personal work. They are a tight supportive group to each other now and it has been good to watch their bonds develop. They are pleased with themselves and their new abilities. Today's work was laced with courageous vulnerability, a lot of girl talk, mutual commiseration about fat tummies and how to get rid of them, joking with each other , and playing with Mary Lourde's 8 month old baby , Prince, all of us taking turns with him on our laps. It was a sweet time.
Yesterday's training with more Friends in a camp was a less than stellar day. We were tired, but this group of Friends seemed more spaced out that other groups, and some never really caught on very well at all. That was less than encouraging to me, but it was a good learning tool for the team to see that there can be such variety in the groups that we teach, and concomitantly variety in our results and satisfaction. The one thing that always goes over in every group is the participants leading singing, dancing, sharing of jokes,poems or stories. They also love how it feels to them when a resource settles their bodies. They like knowing about ways of connecting and communicating with their older people, and they always like learning that the reactions that they and others are having in the camps are normal reactions in response to extreme events. When they practice teaching about how trauma affects our bodies, they are very proud of themselves. What continues to be very spotty is their learning the skills themselves. It was discouraging to me not to have made it work better today. I have the disease of all the care providers here- if we don't feel like we made enough of an impact, there is no payoff.
Here is the cholera update: rapidly rising 12,000 cases. Anyone with diarrhea needs to get oral rehydration salts immediately. Since there are no labs in Haiti, it is treated as cholera by clinical symptoms only. If it doesn't work in an hour, they have to get IV fluids and tetracycline. If they are not treated immediately, they can die in 6 hours. Getting people to a hospital is a serious challenge with the traffic here which can take an hour to go 5 miles. If they cannot get better sanitation in the camps, people will continue to be drinking water with fecal contamination, and it will continue to rage out of control. They are distributing chlorine tablets that people can purify water with. I wonder if they will get the US military in here to help with setting up IV's. I don't think there are near enough nurses, nursing students, or doctors here to take care of it. I am living here at the house with all the supplies and a doc, and our water is clean. One tragic thing that happened a few days ago is that a political candidate got on the radio and warned people not to touch anyone with cholera. A man died when people were afraid to take him for treatment. They are trying to counteract this with public service announcements telling people it can only be transmitted through contaminated water. There is a very aggressive tent to tent campaign working to do hygiene and intervention teaching . This country really isn't going to get anywhere without proper sanitation though. Dumpsters and the streets are strewn with garbage. This is a very mountainous country. A good rain or a mudslide washes fecal material into the creeks and rivers. It is not pretty.

Friday, November 12, 2010

Fiona doing a demonstration

Fiona, one of the nurses teaching

One of the Friends asked me today,what I thought of Haiti. I told him that although I find the infrastructure horrific , I love the people. Though people are people and of course there are many differences, this is what I love. Haitian people really look to connect. They are incredibly friendly and usually look at me in the eye, interested to check me out, with an expectant invitation that seems to say to me- "just try a little and I'll be there right with you " And that's the thing- such a little bit goes such a long way here. I feel respect without being deferential. I hear a melodic voice that is rich in its fluidity that draws me to it.( It's also great fun how forgiving they are about my French and pathetic attempts at Kreyol). I see a light-heartedness in the midst of devastation, a curiosity that is compelling. The community is very open with each other and with me. I see much purposefulness among the HelpAge national community that has an earnestness laced with a smile. All the HelpAge staff looks out for me everywhere I go, not in a "she's an American and we have to be careful with her" way, but more like " you have come a long way and we appreciate that you want to be here with us".
A big learning for me today was that because we were late coming from one training to another (about 1 and 1/2 hrs), many of the Friends left so we ended up training just 8 . Felt like I had died and gone to heaven. Even though we were in a dirty, dark, kind of smelly shed-like structure in a rough camp, there was no loud generator going like yesterday. Training 8 instead of 27 is a cake walk. The Friends, 7 older men and a women were really touching to me in their attentiveness , very willing to talk about their own difficulties as part of the practice, and seemed genuinely moved about feeling more balanced having experienced the work. Research has come out that it may be less about what therapeutic modality is being used, and more about the quality of presence of the practitioner. Each person on the team has that down, and I think that at least matches skills as the healing element . The nurses took another leap in their teaching the skills, and we left feeling very accomplished. It moves me to watch more and more Haitians become trained to help their own people . And as they do, their pride and hope is palpable. That's where the healing has to come from- not from internationals. The only business we have here is to train.

Thursday, November 11, 2010

Steeve, our psychosocial coordinator and Mary Lourdes, one of the nurses with me
Juna, one of the nurses teaching at the camp in Delmas

Somelia, one of the nurses, teaching

Teaching the Friends about the resilient nervous system by waving a sheet

Steeve supervising a practice session
Training in the tent at Croix des Bouquets

We just ended our second day of training in the camps for the "Friends"- camp residents (many older people beneficiaries themselves). The training yesterday at Delmas was really hot and crowded in a pretty small tent for 38 of us, but it went great. The camps are pretty grim places- hot, crowded, dirty, tense on the verge of cholera and constant hunger. Our tent however was extremely spirited with lots of singing and dancing led by everyone- facilitators and trainees at different times, creating lots of energy intermingled with painful stories and earnest learning. My trainees from the previous 3 day training all jumped into the water with quite a bit of success. Many of the Friends at Delmas were educated, some teachers, who picked it up pretty quickly. Others were slower but started to get it after practice sessions. The stories in the practice sessions where Friends all got a chance to be the "patient", were crushing, filled with so much loss, horror and devastation. But so many were able to identify resources that allowed them to make a shift from heaviness, palpitations, muscle tension, bodily pain to a calmer, lighter balanced nervous system place. They were incredibly appreciative,and began inroads to learning the Trauma Resiliency skills of tracking, grounding and resourcing based on Somatic Experiencing principles. I cannot imagine any other therapeutic modality that would be more appropriate for Haitians in the camps. They carry so much of their emotional lives in their bodies, true to Scaer's work that the body does bear the burden of trauma. The facilitators are getting excited seeing this work in the camps. We all were very quiet on the ride home, pleased, exhausted, and sobered.
Today's camp at Croix des Bouquets was a totally different story. The camp was the last thing you will ever see resembling a Cross of Flowers. It was very rough, this time no USAID nice tents like Delmas, but only makeshift tarps of any which kind of material held together by duct tape. It is next to a polluted river filled with garbage and I saw no clean water source. Don't know about the latrines there either, even if there are any. I continue to be amazed that in an 8 hour day out I never feel the urge to pee. It doesn't even cross my mind. I guess when you know your only option is the Haitian squat, it leaves your possibility sphere.
The Friends in this camp were mostly illiterate and much slower to get the concepts. We were in a much bigger tent this time, which was lots better in terms of air moving through, but there was the loudest generator going the whole time we had to practically yell. The whole training just felt more chaotic to me. And certainly I chuckle to myself thinking about our American standards of what a training venue should look like, and what the educational credentials of those trained should look like. After this, I think doing a training like this in a screeching NYC subway station would feel like a conference room in the Ritz Carlton next to this. The nurses made a quantum leap in their teaching skills today, which was encouraging to me. But the Friends had a much harder time grasping the skills. They were convinced the way to help their older people was to tell them to forget about their painful thoughts and pray to Jesus. It took a lot to try to convince them that while it would be great if we could just forget about our painful thoughts, but it just isn't that easy. When we could get them to think of a specific time that they remembered really feeling the presence of Jesus being with them, and notice what happened in their bodies when they thought about it, then we could use their faith as a resource to re-stabilize their nervous system. So far, my experience with most of the Haitian camp residents is that their faith has been strengthened since the earthquake, deeply believing that God has and will bring them through this, as well as their lifetime of adversity.
All that said, the Friends were quite attentive , joyful in their singing, and very engaging and appreciative. Pretty amazing.
Cholera on the rise. Ndaro says Haiti is in for cholera for years. Deaths up to 700. No fruits and vegetables for me this trip.

Tuesday, November 9, 2010

Practice sessions

Handing out certificates

The third and final day of this training is over and I am so pleased. The trainees have done so much courageous vulnerable personal work in the role plays, that now several of them are ready to train others in the camps, which we begin tomorrow. After a really tough day of long practice sessions that were extremely intense emotionally, we ended the day with graduation, all singing "Lean on Me" together led by Juliette, my fabulous interpreter, with her gorgeous strong voice. Everyone was very proud of their certificates with cameras going off every which way with their holding up their certificates beaming with me standing next to them, The group really bonded, and true to form, one of the nurses came up to get her certificate while talking on her cell phone. I finally figured out today that they were not only on the phone or texting about work stuff, so I at least put the kabash on the phones while we were in practice sessions.
I am so lucky to get to participate in this healing community and am so touched by these men and women who want to help heal themselves and their country. The life force is so strong in the midst of this chaotically dysfunctional country. We have had such a good time today singing loud together in between each practice session with a number of different trainees each taking a turn leading us. It was such a fun break. This was a very good day.

Monday, November 8, 2010

Steve and a few trainees pushing our truck to give it a running start to take us all back home at the end of the day

I just finished the second day of this first three day training and feel like I am running a marathon in a minefield. Many of the participants are talented and willing, but many have been so traumatized since the earthquake that I am having to negotiate how to work with them appropriately for their own self care, and teach them how to be trainers themselves of other care providers. Several men claim Jan. 12 as a day in their life that they feel good about themselves because they had the courage and fortitude to help people get out of their houses and help the injured. Those that barely made it out themselves and lost family members and couldn't help anyone because they were so debilitated themselves, feel tremendous shame, guilt and loss. That said, these men and women are all heroes to me the way most of them can laugh and sing and dance and connect with each other . And they are so wonderful to me- so appreciative, warm, supportive, inquisitive, real and willing to be vulnerable. Practice sessions have been good today but way behind because there is so much personal work that needs to be done for the nurses to move forward. It is happening, but slow, so I have to figure out how to spin something tomorrow that gets us there so that they have all done one and practice teaching one. This is hard work trying to figure out at night how to make each day work after the challenges of the previous one. We lost an hour and a half today because of transportation issues ( a day in the life of Haiti). That doesn't rattle me at all, given that keeping the trains running on time has never been my strong suit. Luckily they have a logistics person that is taking care of all that, but cars invariably break down and get stuck in crazy traffic. Everyone has to be transported from all over the Port au Prince and Carrefour areas, so it is a total crap shoot when everyone will actually be there. And then there is the matter of the cell phones which have to stay on because all of them are in leadership positions in the camps and there is a cholera epidemic going on. Every person with diarrhea has to be evaluated immediately, re-hydrated and referred fast if they have cholera. The cell phones are having to be responded to all the time, so it feels like I am teaching in a 3 ring circus. I am the only one that is not mainlining with my blackberry. But I have to look at the other side that these people and their bosses feel like this is important enough to field everything else to be able to do this. That is pretty awesome. I hope maybe we can make a dent.

Sunday, November 7, 2010

Lunch at Fabbius' restaurant, a reunion for Fabbius, Ndaro and me.

Street market scene, dumpsters are piled up at the end of the day and often not emptied.

Trainees getting a ride home.

A few of our training group at Censhop.

I started my part of the psychosocial training yesterday at the Censhop Hospital. I have 16 participants, Steve, the HelpAge Psychosocial coordinator, 4 HelpAge nurses, 2 HelpAge public health docs, 2 program people from HelpAge, a HelpAge community agent from the camps, the medical director of the Censhop Hospital, and 7 other healthcare providers from other NGO's. They are a wonderful group who are eager to learn and seem pretty engaged. They are practicing skills in small groups in breakout sessions that they can use in the hospitals and camps with people who have PTSD and depression. As a whole group we are having lively and touching dialogues about how to do the work with the particular challenges that older people face in the camps, and how to apply these skills to themselves, all whom are Haitians who have personally been through the earthquake here and are still dealing with their own losses of home and family members, and traumatic stress. My interpreter is top notch and is familiar with the material I am teaching and is also helpful with the small breakout groups. We have 2 more days together to do the "watch one, do one, teach one model", so by the end of tomorrow they have to have learned all the skills themselves, so we can be practicing their teaching the skills Tuesday. Starting Wed. a team of us will go to a different camp each day to teach the skills to a group of 30 "Friends", who are camp residents that HelpAge is paying a small part time wage to be health "carers" . The Friends have about 20 older people in their camp that they look in on each day to provide assistance. I am hoping that we can train 150 Friends before I go this time. I know from the time I spent in the camps in August that we will run in to many Friends that are really challenged themselves not only from the loss and trauma from the earthquake, but every day living in the difficult conditions in the camps , often not knowing where their next meal is coming from for themselves or the older people they are supposed to be helping.
Today Sunday has been a really good day off for me. I went to see my friend Mike, who has been here in Haiti running a big USAID program which has been helping Haitian farmers change to and multiply crops to export. He lives outside of Petionville high up on a hill that looks out all over Port au Prince and the ocean- a breathtaking and awesome site to see so many clumps of camps. This afternoon, Ndaro and I were invited by Fabbius, our Haitian driver and interpreter from when I was here in August, to his restaurant for lunch. It was a warm and engaging reunion, a great stew, and lively discussion about Haitian politics, Tanzanian Christianity and voudu. We went the "back way" to avoid traffic and had quite an adventure with Claude our driver, who had to make many attempts to get up the muddy rocky dirt roads, winding around hairpin turns with huge deep holes , through little rivers strewn with garbage. Carly (my daughter who shirks over my driving) would have gone crazy. I am now back at the house safe and sound, happy to have had two really fun times with friends, and ready to review for my training tomorrow.