It's 10:30 am. Geoff and I ended up going to the hospital this morning, instead of the Citadel hike. We were both eager to get to work. It's nice to have someone familiar here, especially because the language barrier is so great. I do understand some French, but Creole is a whole different thing. Then again not so. For example, butter = beurre, this I know, but in Creole, it's bu. You can see where that comes from and with the accent it still sounds like beurre. So i think maybe I'll catch on a tiny bit. But then there are words from who knows what African languages mixed in, and then there's the patois, and the accents. Oh boy! Toto, we're not in Kansas anymore!

First we went to the NICU with Nandina, a lovely Cuban doctor who speaks Spanish and Creole. This was helpful because Geoff is very competent in Spanish and I can understand enough to listen without having every word translated. And she could talk to the patients. The language barrier will be my greatest impediment to patient care. By the way, do you know that many of the interpreters here are men who were busted on drugs charges in the US and deported? They speak English so are highly employable here! This is not a joke -- it is true.

We then spent a good bit of the morning going around with Dr CC. He is from Guinea Bissou and here for 17 months now. We went around to see the newborns, little kids, went to the surgical wards, and then through the ED and med-surg tents.

There are a great variety of conditions here. In the NICU was a baby born macrosomic and hypoglycemic; the mom was not diabetic according to the charts (which are in Creole, by the way, so it takes some deciphering), but really the NICU docs don't know anything about the moms or the babies, or just the most minimal information.

Another baby is in the NICU for 3 months getting AZT therapy which appears to be available on some kind of grant. Most of the mothers breastfeed very openly here but because of the HIV this baby can't be breastfed, so he's here for feeding. Another baby has RH-incompatibility and needed transfusions for severe anemia. She's been here for a month and would practically fit into Michael Jordan's shoe (i.e. she's really small even if his shoes are big).

I went to change the poopy diaper of a crying newborn, only to discover there were no diapers. I saw some on the windowsill near the next bassinette over, but Geoff smartly pointed out that they probably were brought in by a different family. He was right. In fact, families bring in almost all the necessary supplies for their hospitalized family member.

The kids had a variety of conditions: traumas including scooter (that is, motorcycle) accidents, burns, and other accidents. There are many skin infections. I've never seen filariasis before; just in pictures. It's very common here. (I think I'll keep my shoes on and probably won't wear flip-flops outside of my room and the shower!)  Filariasis is the parasite that causes what is more commonly known as elephantiasis. Look it up and you'll recognize it. I felt the leg this morning of a woman with it. It's incredibly large and taut. I was unable to ask whether it is painful.

Scooter accidents are incredibly common. People squeeze as many as 7 people on them. This morning I saw a dad with a toddler in his lap driving one, and sitting behind him was the mom with a very young baby lying across her lap.

We checked on the woman who had an above-the-knee amputation last night. She was sitting up, happily, with a family member caring for her. She looks amazing!

The porch is cool and comfortable. There is choir music in the background. This is a very religious, spiritual, and superstitious country. I'm going to read up on a few things that are going to be especially helpful. I am going to especially brush up on my neonatal resuscitation. It sounds like efforts are sketchy here but that they do have Ambu bags, so at least I can do what I can if a baby is born distressed, which in all likelihood will happen.

There is loud call-and-response hallelujah coming from a church nearby. Cars, trucks, scooters going by. It seems anything bizarre is possible here.
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As I left off this morning, we were planning a horseback trip up the mountain. As you can see from the photo, this actually happened. I only wish you could see a film of what I saw/heard/experienced today. It was incredible on so many levels. And it was just pure taking in with some thoughts interspersed, but not many. It was all new and fresh and technicolor. The colors, air, sounds, scents of Haiti -- they are so rich and stimulating, but in a non-hectic soothing sort of way. I feel like I got to see the lesser-seen parts of this town today. And with a bit of Creole schooling along the way. Thank goodness for middle school French. It's actually surprisingly helpful.

The journey started with our guide telling us he was ready. We were to paying $25 dollars (US) for the horses. We walked toward the hospital gate, which is open during the day, and where three small horses (we'd call them ponies at home but they are full-grown horses, just some small species) were waiting for us across the road. There was a group of youngish Haitian men with the horses. Between us and the horses was a security guard and a group of men in outrageous and intimidating black costumes, masks, and wigs fake verbally accosting the security guard. It took me a few minutes to sort out that this was just a theater group and not some outburst in the making. Our guide got us to the horses past the ruckus of the actors, and we began our 7 km round trip journey from sea level to 3000 feet where the Citadel is located, and back. It is so high that you can see the DR from there. We were to ride there and walk back. It was a several hour journey that began at about 1:30 and we just returned at about 6pm. It's been dark for about 30 minutes.

My horse was led by a young Haitian man who periodically reminded me not to forget his name and his good service (not too subtly prepping for a tip at the end -- this is ubiquitous here). We not quite trotted not quite walked through town over cobble-stoned roads filled with people walking, children playing, dogs, and goats. We cut up narrow little side alleys between homes, and through parts of town iId surely not venture to on my own, but which are fascinating and colorful. It's Sunday, church is out, and people are everywhere. Walking, sitting on front stoops, and on porches. Stores seem closed but vendors have simple wares and food here and there. The streets have much litter along the edges, but are generally clean on a macro level. On a micro level -- well I'd not walk barefoot here under any circumstances, but children everywhere, of course, do. Little girls are curling their mom's hair, moms are combing out their daughter's hair; families are together just hanging out. There is music -- live and radio. Every kid wants a dollar. A few toddlers yell out "Blanc" as we stride by (Blanc just means white person, it also sort of means "gringo"). The horse ride was somewhat relaxing (my thighs are now killing me! and Kim Land, my dear friend, I now know why at 45+ you still have the most kickass legs!) though there were some steep inclines. And there was that road grate that my horse suddenly decided to jump. The trip was a botanical paradise: cacao, breadfruit, soursop, grapefruit, oranges, mango, coffee, squash, sugar cane, okra, fava beans, castor bean, poinsetta trees, bananas, and so many herbs I wish I knew but didn't, all growing by the side of the road. There were gardens in seemingly impossible places. There was a small open building with colorful paper cut outs hung all around like Tibetan flags and a chair tied high up on a pole with a picture of perhaps a saint on it. I later confirmed my suspicion that it was a Voudon house -- a place of worship. It was both bright like it could have been somewhere that a child's birthday party just happened, but also foreboding and not somewhere to trespass or photograph.

The air became cooler as we climbed, and it was slightly cloudy, so the temperature was comfortable. I relaxed into the semi-rhythmic pace of the ride, just taking it all in. The view also became breathtaking and I understood why Paul Farmer's book was called Mountains beyond Mountains. We could also now see the sea. So lush. Not the deforestation I'd so heard about Haiti, not here in the north.

We arrived at the base of the Citadel, paid our 'horse men' not $25 dollars but $25 per horse, including the guide’s horse, and a $5 tip was expected for each of the 3 'horse men.' We explored the Citadel for a long time. That same king, Christophe, built this fortress, which my co-Haiti colleague said is larger than many of the fortresses and castles he's seen in Europe, to protect himself and his kingdom from Napoleon. We saw many of the over 200 cannons that were hauled up by slaves, cannon balls in the fort, the prison, and the cisterns and water system. This is an impressive feat architecturally at that altitude and just generally. It's also beautiful. The whole place is built of stone and the mortar is a mixture of cow blood, gelatin, limestone, and some other ingredients. It's 200 years old and this is how it's held together.

The descent on foot was long and the road very uneven stone. We walked passed scads of interesting homes and families, men in groups, women in groups, tons of children and a lot of goats. The babies -- both human and goat -- are ridiculously adorable. On the way down our guide cut pineapple sugar cane with a machete and gave us each about a 12 inch piece to eat on the way back. It was sweet but not too much so, and refreshing.

We arrived in the main part of town nearly at dark. The town was still bustling and colorful and alive. My legs ache and I am tired but peaceful, and feel so enriched seeing how people here live. It's bare bones, low carbon footprint, remarkably simple, and while poor, rich in other ways.

I am tired. I start on ob at 8:30 tomorrow morning, actually, a very decent hour! So I'm going to sign out after a private email to my guy manning the fort at home, and get some sleep.

Bon nuit, amis!