On the walls: part 2

My mom was here last month, and she is in general a better photographer, with a better camera, and less shy about taking pictures than me – so the next few posts will include her photos, as these three below to continue the ‘walls’ series.

Election graffiti and red MTPTC sign

MTPTC is the Ministère des Travaux Publics, Tranports et Communications, which undertook large-scale building damage assessments after the earthquake (with the support of partners). Red = dangerous building, entrance forbidden, to be demolished or requiring major repairs. Yellow = dangerous building, limited entrance, requiring minor to moderate. Green = not damaged or superficial damage, immediate occupation/return is safe. By July 182,850 structures had been assessed, 47% green,  27% yellow, 24% red. I will try to find more updated figures.

The blue graffiti says “change = Baker”, who is #40 on the election list.

Visual marketing

Little shops are in general very visual in their marketing. If you can eat chicken in the restaurant on the street, there will probably be a chicken painted on the front. If the shop sells ‘diverse products in retail and wholesale’, these will be listed on the front, usually in paint too, sometimes in creative fonts (pictures coming soon). So in this case, it’s also clear what Nick’s Exterminating exterminates!

The way products are sold on the street is also very visual, products stacked in high piles so that each is visible, pretty much in a ‘you can’t buy what you can’t see’ fashion (again, pictures coming soon).

Another wall

Less special than the artistic graffitis or entertaining store-fronts, this is a pretty standard wall for these days. Election posters and graffiti. The ‘Studio de Beauté’ sign on the bottom left indicates the building housed a beauty parlour on the ground floor before the earthquake. The state of these buildings is still very, very common.

P.S. – For those interested in health/development/access to medicines/aid logistics, I’ve added a new section with useful resources. Recommendations are welcome. I also updated some practical details about living in Haiti (at the bottom of ‘More on Haiti’) for anyone moving here soon or new in the country.

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On the walls: part 1

There is a lot of life on the walls in Port-au-Prince: (election) graffiti, election posters, graffiti art, the label from the Ministry of Public Works and Construction to say whether the building is safe to live in or not after the earthquake, and many advertisements! Three graffitis for today:

A personified Haiti in the national blue and red; woman and children under rain

A crying man

One of my favourites

P.S. – I have been a little lost in my own thoughts, to explain the recent lack of posts. Also, some photos of walls might be a bit thin for those expecting commentary on what everyone sees on the news. As a quick update:

Hurricane Tomas (5.11.2010) definitely did some damage, destroying (flimsy) homes and causing floods and mudslides, but it was luckily not as bad as feared. Some of the worst affected areas (especially on the coast south of Port-au-Prince) are also some the worst affected areas after the earthquake. Haiti doesn’t get it easy…

For those who want to know how it was like for me: I was simply in my apartment, with a large stock of canned foods and that kind of thing, just in case. The water reservoir on the roof was filled to be sure to have enough water – and so the roof wouldn’t fly off. But it was not very dramatic, a lot of wind and rain pouring for hours. I live in an appartment on the bottom floor, which is partially under the street level, so it’s all quite protected from the wind, it was a lot more dramatic in other places.

Cholera: “Over 12,000 Haitians have so far been hospitalized for cholera, and over 800 people have died from the disease, which is spread by contaminated food and water. Up to 200,000 cases of cholera are expected to be reported over the next 6 to 12 months.” (UN News, 15.11.2010) NGOs and the government are working really hard in their response, both in terms of prevention (a lot of community training, radio announcements, soap distribution, etc.) and treatment (procurement of medicines and supplies, setting up Cholera Treatment Centers, delivering treatment, etc.)

For those wondering about me again: I have been a little involved, liaising partners here in need of medicines and supplies with IDA in Amsterdam, and in touch with the Ministry of Health on how else we can contribute. However, I am by far not as busy as those working for the medical NGOs and local organisations and hospitals of course, who are under a lot of pressure. And I’m healthy, eating clean food, drinking clean water, washing my hands, no worries for my health.

The upcoming elections are regularly causing demonstrations, sometimes not entirely pacific (throwing stones at cars), but it’s hasn’t been very dramatic either. Though today I did hear there had been some shooting in Jérémie (city at the end of the south-west part of Haiti), but couldn’t confirm it yet. The four names I hear most often in terms of favourites are Jude Célestin, Mirlande Manigat, and Jean Henri Céant, and Jacques-Edouard Alexis.

On the other hand, there was violent protest in Cap-Haitien (on the north coast), but this seems more related to the fact that some Haitians have grown suspicious of UN facilities after a rumour began that a peacekeepers’ camp was the source of the original cholera outbreak. Official response is that this is in no way proven and that the source is probably impossible to identify.

I am careful as usual and keep up with some sources to try not to end up somewhere at the wrong time, but I did happen to drive through the beginning of a demonstration once. It was quite calm and we drove through in about a minute. Like I said, I am careful. The days around the election I will stay home.

Soon… more wall photos. I like sharing more of Haiti than its disasters and politics.

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When you don’t know

“…I would like to beg you … to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.”

Letters to a young poet, Rainer Maria Rilke

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Cholera outbreak

For everything that has not improved since the earthquake, one positive thing had so far been no major disease outbreaks. Now:

“Government officials confirmed a cholera outbreak in the Département Artibonite. The Ministry of Health reported the worst-affected areas were Douin, Marchand Dessalines and areas around Saint-Marc, approximately 100 km north of Port-au-Prince. More than 1,500 people are reported to be sick. The diseased suffer from severe diarrhea, which leads to extreme and rapid dehydration, which led to death in at least 141 cases so far. The Artibonite River is likely to be the source for the outbreak, after recent heavy rains spurred its banks to overflow and flooded the area.”

Poor water and sanitation facilities is the best way for cholera to spread quickly, and this is definitely an issue, especially in the IDP camps. The government is preparing an information campaign on prevention. Medical NGOs are getting ready to set up Cholera Treatment Centers as soon as they receive the authorisation.

In the midst of all this activity, I do feel quite powerless. The office in Amsterdam is currently checking our stock on the specific products needed for cholera treatment, and contacting suppliers in case we need more. IDA will of course do its best to provide what is needed quickly, but we can’t do much before actually receiving orders from NGOs or the government.

While I am powerless in the face of pretty much all challenges here, this is in the health sector, so it feels closer.

An American who grew up in Haiti and is currently involved in reconstruction efforts told me that it was important for people/relief workers to stay focused on their specific tasks – not only does it allow them to work better by focusing their energy, but worrying about all the different problems is too heavy. It’s not that you shouldn’t consider what is going on around you and outside your own work, but constantly facing all of the suffering head-on is too much of the opposite. I think that was good advice, and think of it when I feel particularly powerless.

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Health care and the art of motorcycle maintenance

Check out this interesting article which highlights the importance of logistics, ‘basic’ things development projects might sometimes mistakenly take for granted, and thinking sustainably.

Excerpt: “Until 2008 Kotelo could visit only three villages a week, because he had to reach them on foot, walking for miles and miles.  But in February of that year, Kotelo got a motorcycle the best vehicle for reaching rural villages in Africa, most of which are nowhere near a real road.  Just as crucial, he was given the tools to keep the bike on the road:  he received a helmet and protective clothing, he was taught to ride and trained to start each day with a quick check of the bike.  His motorcycle is also tuned up monthly by a technician who comes to him.  Now, instead of spending his days walking to his job, he can do his job.  Instead of visiting three villages each week, he visits 20.  Where else can you find a low-tech investment in health care that increases patient coverage by nearly 600 percent?

There’s nothing new about donating vehicles for health care in Africa.  Many organizations do it.  But often these vehicles fall apart.  Barry Coleman says that unmanaged, a vehicle in Africa will usually have a major breakdown after 8 months of use and be junked entirely by 15 months.  This is a classic problem in development:  everybody wants to play the white knight coming to the rescue with the quick fix — the water pump, the $100 laptop, the motorcycle.  But the tougher challenge is developing a cost-effective system to keep things working.”

Of course it also reminds me of the wonderful days in Burkina Faso with Kath & ‘Barack Che’, our motorbike…

Riding in the Sahel

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In the mountains to Ka-Blain

On Saturday I went to visit ‘Ecole Soleil d’Hollande’, a school of Stichting Naar School in Haiti. After about one and a half hour driving up, down and around mountains (but for a total of only about 20 or 25 km), Bastien started asking, ‘Is that it?’ at every little concrete house we saw. ‘No,’ I told him, ‘I think it will be a much bigger building.’ Indeed, after one more turn, we suddenly saw a large building, several stories high, nested in the beautiful mountain landscape. (You can see photos of the school on their website, it took me long enough to upload the ones below!)

Founded by Marijke Zaalberg, a Dutch woman who had previously worked in the orphanage which I visited a few weeks ago (see ‘First impressions’ post), the school in Ka-Blain is one of three built and run by the foundation. It counts about 1,200 students, children of the peasants who work the fields on the mountain slops around Ka-Blain. I don’t know everything they grow, but it includes cabbage, sprouts, carrots, and potatoes.

The landscape to and around Ka-Blain is gorgeous – when you can see it that is, as when thick fog surround the mountains, you can barely see 100 m in front of you, literally in the clouds.

Around Kenscoff

Kenscoff, about 15 km south of Port-au-Prince, is one of the areas in the mountains a little outside the city (sometimes overseeing it) where wealthy Haitians build large houses. Owning a house in such an area is a clear status symbol. You can also see the thick fog hiding the top of the mountains.

Dye mon, gen mon

‘Behind a mountain, there is a mountain’ – Haitian saying. Mountains beyond mountains is also the title of a book by Tracy Kidder about doctor and anthropologist Paul Farmer, the founder of Partners in Health. A definite must-read.

Vegetable fields on the mountain slopes

More mountains

My camera doesn’t do them justice, it is really a spectacular landscape, appearing in and out of the fog, rolling under shadows and rays of sunglight.

Fields and peasant homes

Ka-Blain is not that far from Port-au-Prince, but it is a completely different world. Though a different kind, it remains survival. Farmers cultivate their plots of land to feed their families, and those with greater plots send their vegetables to be sold in the city. People walk up and down the mountains to work in their fields, build their houses piece by piece, and sell their goods.

There is no health center close by. But there is Ecole Soleil d’Hollande, which is not only a school but also employs one nurse who provides basic healthcare within the limits of the means available to her. They also were the facilitating recipient for a project which is currently building 50 prefabricated wooden houses for the peasants in these mountains – a welcome help when most of the relief efforts are focusing on the city. (That’s the second prefab house project I visit – these houses, or rather ‘temporary shelters’ for 3-5 years, are a big part of the earthquake relief response, and I will write a post on them one day soon, with photos, so you can see what it really means. The houses in this photo are not prefab, they are normal local houses.)

Boys in Ka-Blain

The boys are striking poses of their choice! Behind them is Marijke, who first came to Haiti in her forties. Though with the unmissable support of her foundation in the Netherlands and her local partners, she pretty much single-handedly went from a small kindergarden school hosted by a local church, to three schools in the region.

More fields and mountains!

It was really a lovely day in Ka-Blain!

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Some photos in Port-au-Prince

Something to give a little taste of details in the city (sorry about the poor quality, these were mainly taken from the car):

Traffic jam in Pétionville

Bastien (the driver) and I are stuck in traffic between one and three hours a day. I’ve arrived a half hour early to appointments because there had unexpectedly been no traffic. Getting a bump from another car as everyone is trying to squeeze through is also relatively common (4 times in 3 weeks). It’s like ‘bumper cars’ meets ‘the game of chicken’, the whole generously seasoned with honking of course. Luckily the rented Chinese ‘Chery QQ’ car already had a fair amount of little bumps and scratches.

Ten months after: one of countless buildings destroyed by the earthquake

A house after the earthquake which struck 10 months ago. This one looks like it was new, and was then probably empty at the time of the earthquake – it may have been built with the savings of Haitians living abroad, who don’t have the funds to clear it up and build a new one.

Green and yellow bottles for Brasil

The bottles are painted in green and yellow – most Haitians were fervent Brazil supporters during the World Cup, with a minority group also rooting for Argentina. Their flags and colours are everywhere. In fact, Inité, the political party of presidential candidate Jean Auguste Célestin (supported by current president Préval) has chosen green and yellow as its poster colours.

Election posters on monument celebrating 200 years of independence

I also took this picture while we were stuck in traffic. This little monument commemorates 200 years of independence – that’s right, Haiti is older than Belgium. It is covered with election posters.  The elections, for both Senate and President, will be held on November 28th. There have been musical radio advertisements enticing the population to vote since I arrived 4 weeks ago, but the official campaign only started on the 27th of September. Prior to this, there were only tags on every other wall in the city, as well as nameless green and yellow posters (which then turned into Inité party green and yellow posters). Once the official campaign started, the city was covered in posters in one day (and apparently the entire country too). The current campaign phase is a ‘silent’ one – public speeches and gatherings are only allowed from the 15th of October on, and until then only posters, stickers, brochures, and messages written on the Internet are allowed.

There are 19 candidates for the Presidential post. It includes a Michel ‘Sweet Micky’ Martelly, a popular musician, as well as a white man, Charles Henri Baker (I was surprised when I saw the posters, but there are white Haitians and he is one of the richest men in the country). Wyclef Jean was not allowed to participate, lacking prerequisites like having lived in the country for the last 5 years.

Jude Célestin of the Inité party is supported by the current president, René Préval, as well as by ‘The 15 Families’ of Haiti. These are, from what I understood, the 15 wealthiest families in the country, and along with Presidential support this makes him a kind of favourite. However there are other favourites, opinions differ as to who will really win.

It seems that the poor, i.e. the majority of Haitians, are not very interested in the elections, as they do not feel any candidate really represents them. I have also heard that many will support the candidate which ex-president, Jean-Bertrand Aristide, currently in exile in South Africa, and whose Lavalas party was not allowed to take part in the current elections, chooses to voice support to. It is so far unknown whether he will at all.

However, seeing as I don’t really know the country and that the opinions I have heard are much too few to be representative, you should really not take my political observations too seriously.

A real hero in Haiti

A paiting of Maradona at the back of a decorated minibus (taken, again, during a traffic jam). Along with such minibuses, the local public transport is the ‘tap-tap’, something between a minibus and a pick-up truck, open at the back for people to hop in – or hang from when it gets full – with two benches opposite each other under a little roof. They are often colourfully decorated, with paitings of celebrities, Haitian sentences of wisdom, or quotes from the Bible.

After photos from the city, countryside coming up this week!

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FAQ: do I feel like I’m making a difference?

I’m not a humanitarian worker, one that walks around the camps teaching people how to set tents up efficiently and trains local community workers on how to promote washing your hands and drinking treated water. I’m not a doctor, not a teacher, and will be of little use to determine where it is safe to rebuild houses. And to be honest you won’t find much in my blog that you can’t read in the newspapers, in Haitian cooking websites, or blogs of other people dealing with the challenges of living in low-income countries. So am I useful, here in Haiti?

I do believe that as part of IDA, I am working to make a positive contribution through improved access to quality medicines. It’s not the only thing that matters, but it definitely matters. There are different channels through which public hospitals or humanitarian projects in Haiti can buy medicines: there’s a central medical store, there’s the private market, and some also import directly. I’ve heard enough pharmacists or heads of health projects tell me, ‘Yes, buying medicine through supply channel A is more expensive than through supply channel B, but when channel B is empty, we still need the medicine, so we’re going to buy from channel A, as much as we can!’ This tells me there’s a role for IDA – our mission is to make medicines available that are both affordable and of high quality, precisely so this pharmacist can fill his pharmacy with what he needs.

Of course I’m just one person, but, at the risk of sounding super corny, 160 ‘one persons’ of us make realizing our mission possible. My little role for these few months is to link the field to our headquarters. When I tell one pharmacist here that shipping from the port of Rotterdam to the port of Port-au-Prince takes 29 days, with a possible 2 to 3 weeks delay because of transit which we can’t control, and that based on his order details, this means we can ship in 3½ months, including time for him to get the goods out of customs once they arrive here, I’m not going to be the one processing his order, picking it from our shelves, ordering the missing ones from manufacturers, booking the shipping line, loading it into a container… It’s the whole IDA team, plus the manufacturers and the shipping line and the customs officials and everyone else, who actually get the goods delivered. Yet when I tell him 3½ months, as we sit at a table with supply chain diagrams and an Excel sheet of medicines, I feel personally responsible for these months, I want to go back to Amsterdam or to the manufacturers and load their medicines into my bag and not let them go until they are in his hospital! (Which would be a highly inefficient supply chain..)

Another pharmacist of a large organization here told me how IDA coincidentally delivered his last annual shipment just days before the January 12th earthquake, and how their response would have been a lot worse without it. I can hear the emotion in his voice as he tells me this, and explains that now it is important that the next order arrives for New Year’s, are as right after New Year’s there is always a peak in patient visits.

I visualize the steps necessary for his order to reach Haiti in December, the long chain of hands typing and calling and clicking and packing and carrying and checking, almost like in the terrible first scene of Lord of War when a bullet is manufactured, packed, shipped, is picked up, loaded into a gun, and ends up in someone’s forehead. A bit of a bloody comparison, I concede, especially as medicines should be doing the opposite.

Then at the other end, I imagine the waiting rooms. I have visited a few hospitals here in Haiti, and pass through waiting rooms of others on my way to the pharmacies, but I mainly know waiting rooms from Burkina Faso, where two years ago I conducted interviews in over 30 health centers as an intern for the World Food Programme. There, in the Sahel region, the waiting rooms (and, once, patient rooms too) often extended to the simple outside, along the wall of the health center or under a tree. The hospitals I have seen here so far luckily are better equipped. Of course, after the earthquake, entire operations were taking place outside. Because the building had collapsed, because it was too full, or because people were afraid to get back inside. Things have improved dramatically since then.

Waiting rooms smells like disinfectant, and, to be honest, like sick people. This is normal of course. People are waiting, with their children, with a bandaged foot. Some can barely support themselves against the wall, some are hooked on IV. You can sometimes hear painful moments in the operation or delivery rooms – I’ve shuddered hearing a little boy scream his lungs out in pain during circumcision, and saw a little baby bundled in a blanket on a bed after hearing his mother groan through contractions and his birth. There is family to help those who can’t make it alone. It’s really important – in the main hospital in Dori (Burkina Faso) for example, unless it’s an emergency, the nurse or doctor will prescribe a medicine, whose prescription you bring to the pharmacy, which then writes the price down, which you bring to the cashier to pay, and then head back to the pharmacy to collect the medicine, each time waiting in line again. You don’t want to be doing this while in pain, and you can’t when you don’t have the energy to rise from your bed, a shadow of a body struggling to survive.

All of this I remember and imagine, as the pharmacist tells me there is a peak in patients after New Year’s. On one side, the long supply chain, on the other, patients in a waiting room. Some of it may sound a little gruesome, but the few peeks I’ve gotten are far softer than the simple reality nurses, doctors, and patients themselves go through. It’s a world where many lives are saved and wounds healed, but also with a lot of tough pain and loss. The little white and coloured pills, the bottles of iodine and swathes of cotton, the thin needles and transparent IV bags, they are not just details here.

So do I make a difference? We are ants in the cross-continental chain that gets the medicines and medical supplies to the patients. Ants are small and not much good alone, but they can also carry 10 to 50 times their weight (according to WikiAnswers). IDA supplies medicine for some 90 million people a year. That’s a lot of times our weight for 160 people, but it’s worthless without nurses and doctors and ships and trucks and pharmacists and stock keepers and good policy, etc. And to the pharmacist sitting across me, it’s worth a lot less if his stock arrives after the patient peak. I better get my ant to work!

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Electricity/ storm

I’ve just heard that because of the damage caused by the storm last night (what I mentioned as ‘a few electricity posts’ falling) we might have a 3-week long electricty cut! I don’t reallly believe it, but it might at least mean more frequent and longer electricity cuts. We do have a generator here, but as gas is very expensive to run it, we would be trying to keep use minimal. To be continued…

*update* It seems the 3-week long cut is more like 3 weeks of extra instability in the power supply, from a few minutes to a few hours a day. I haven’t got much to complain about:

“A severe and unexpected thunderstorm left more than 10,000 families in Port-au-Prince without tents and tarpaulins. The storm hit in the afternoon of 24 September and brought with it violent winds and heavy rains. Although it lasted less than an hour, the storm created havoc across the Haitian capital. Authorities have confirmed that six people were killed, and power lines and billboards were torn down.

“Because the storm was unexpected and brought strong winds, people were not able to react in time to tie down their tents or secure their emergency shelters,” said Steve McAndrew, head of operations for the International Federation of Red Cross and Red Crescent Societies’ (IFRC) earthquake response.”

More on ReliefWeb. This was the worst storm in this hurricane season, but it is a ‘minor incident’ compared to the big storms and hurricanes possible. Many UN agencies and NGOs have been actively preparing for the hurricane season for months, or are at least keeping informed about ‘contingency plans’. Thanks to this, the response for this storm in terms of bringing new tents and materials seems to be quite good (i.e. according to the news I’ve been reading).

I promised earlier on I would give some figures on numbers of camps: in August 2010 they counted 1,354 camps. They are located in Port-au-Prince and its surroundings, as well as Léogane (epicenter) and its surroundings. If there are 1.3 million people in camps, that makes for an average of 960 people per camp, but it ranges from a few to over 2,000.

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In Holland, people love talking about the weather. Here’s what it looks like here:

A sunny day

 And at around the same time on another day:

Storm with wind and rain

I can’t help but think of those in the camps, living under tents and tarps, when it storms like this. It hasn’t happened very often in the past two weeks, usually it is sunny and warm, or very cloudy and gray but still warm (about 50/50 between these two so far), with a bit of rain once in a while. This storm did bring down a few electricity poles.

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