Things No One is Talking About

There is so much untapped knowledge, history, and news that gets little to no air time in the US. The problem: no one is here to capture it. Reporting (through well-researched articles or books) in Haiti surely takes much more time and work than it would in the US, because of obvious barriers such as language and cultural norms, but also because you need to know people to find anything out. Some thoughts:

1. The current financial crisis. For the last two years, the exchange rate hasn't changed too much. With few exceptions, the Haitian Gourde has been gradually declining in value over the past decade(s), but this past month has seen a major, sharp decrease in value.

This graph, taken from www.xe.com, shows how the Gourde (HTG) has changed in value over the last month, as compared to 1 USD (the higher the graph goes, the more Gourdes it takes to make $1). Life for Americans in Haiti is getting cheaper and cheaper, and Haitians are having to increase their prices to get by.

This graph shows the value of the HTG compared to the USD over the past 10 years. See that sharp increase at the end?

See, I don't know enough about economics to speak intelligently about what's happening. But, if this were the US's financial crisis, the entire country would be up in arms and news sources would be reporting most recent exchange rates on the hour. A simple Google search of "US financial crisis 2015" would deliver thousands of results where one could learn about said crisis, why it's happening, and what we can expect to see next. Go ahead, search "Haiti financial crisis 2015." Nothing comes up except grim reports of how little Haiti has improved since the 2010 earthquake.

Edit 7/29: Thank you so much, Stephanie, for sending me this article (published in the Miami Herald the same day I wrote my blog post) about this problem. Read here.

2. The Dominican Republic. The situation in the DR is getting some media exposure, but it seems to be dying down. Meanwhile, Dominican people of Haitian descent as well as Haitians who have illegally emigrated to the DR, are arriving in Haiti by the thousands. The below map (http://reliefweb.int/sites/reliefweb.int/files/resources/snapshot_migrant_13_juillet_2015_en.pdf) shows where these deportees are arriving. As of July 9th, an estimated 19,138 individuals had arrived in Haiti via official and unofficial entry points. See Hinche? Approximately 3 hours' drive from the border, Hinche is likely to see major growth in the coming months as more deportees make their way across the country. However, in a country with an estimated 40% unemployment rate, an influx of uprooted Spanish-speakers is going to throw one more challenge at the struggling economy.

3. Disease outbreaks. According to MSPP, the Haitian Ministry of Health, Dengue virus does not exist in Haiti. According to the American CDC, all four strains of Dengue are present in Haiti. And, approximately 25% of the volunteers who have spent time in the MFH house over the past few months have tested positive for Dengue or had Dengue-like symptoms. It seems like a handful of Haitian staff and their families have gotten it, too. I don't want to claim that there is definitely an outbreak in the Central Plateau right now, but it made me realize that any outbreak that doesn't directly affect Americans isn't going to be published. It may not ever be identified. Since MSPP claims there is no Dengue here, there are no Dengue test kits (at least in the area) and therefore obviously no one would be identified as having the Dengue antibody in their system.



4. History. There are countless books about the rich history of Haiti, don't get me wrong. The Wikipedia page alone gives a pretty clear idea of how many times the world's first black republic has been crapped on (pardon my language, but it's totally true). That said, there is so much history that is simply lost because it isn't shared or written down. This past weekend, the In-Country Staff and I went to Petionville (the wealthier suburb of Port-Au-Prince), where we chatted with the owner of the hotel where we stayed. He shared with us stories of people he knew who have been tour guides since the 50's, who have experienced all of Haiti's ups and downs, including the Duvalier regime. It shocks me to think how much is happening here and will never be written down.

Zanmi Mwen Yo

While video chatting with a friend from back home (HI JANICE) about the people I mention so casually in my posts, I got the idea to introduce the in-country staff one-by-one. Here goes:


This is Emily. Emily has been with MFH for over a year and a half now. She came halfway through my year here, so we worked together for a while.

Hometown: literally somewhere in Missouri (WHO is from Missouri?!)
How she got to MFH: Through BVS (the Brethren Volunteer Service). Their focus is on simplicity, solidarity, and service.
Superpower: Knowing all the best and worst places to get paté in downtown Hinche.
Quote: <insert sassy Creole slang phrase>
Job: Everything that isn't what Stephanie and Carrie (below) do. Job duties primarily include putting out metaphorical fires, being the contact person for anything MFH-related, all HR, and pretty much all logistics. Her job is the craziest.
Fun fact: Emily knows all the moon cycles and will tell you about them. She is always sending off positive vibes.
Favorite MFH memory: "Every disco night ever."


This is Carrie. Carrie arrived in May to begin as the new Volunteer Coordinator. This is the first time that the Volunteer Coordinator job duties have been separate from other duties. Trust me, it's a full time job!

Hometown: Portland, Oregon - she makes it sound like a pretty cool place.
How she got to MFH: Carrie was accepted to an accelerated nurse-midwife program, and deferred for a year to come here! She will make the most fantastic midwife.
Superpower: Cat-whisperer/scared-volunteer-whisperer.
Quote: "MAAAAAAM" (in monotone) and "NOPE NOPE NOPE."
Job: Carrie handles all volunteer arrangements. She schedules them, helps prep them for their trips, and hosts them while they're here. She is ten times more patient than I am, and gets very excited when people talk about placentas and the colon.
Fun fact: Carrie has an extra fluffy (read: chubby) siamese cat at home named "Glamour Puss," or "Puss-Puss" for short. Needless to say, she is just as obsessed with Ina May as I am.
Favorite MFH memory: "When Camille, Emily and I went to give blood, and on our way back it started to rain. The taxi drivers were racing each other back to the house."


This is Stephanie. She has been here just over a month now, but it feels like she has been here much longer. She is comfortable and easy-going, silly and fun, but is way qualified and ready to do battle with the powers that be (cough hospital administration cough).

Hometown: Doesn't exist because she is everywhere always.
How she got to MFH: She is pumped about international development and had spent a year in Haiti before, so her Creole is on point and she is doing an incredible job at jumping right in.
Superpower: Being crazy productive and professional despite having Dengue Fever.
Quote: "Where even is the hymen?"
Job: In-Country Coordinator is her job title. She is the face of in-country MFH, doing all on-ground networking and all official business. Seriously, she's a badass.
Fun fact: She lived in Tanzania for several years and has been to too many countries to count.
Favorite MFH memory: "When we went out to a restaurant and I ordered pwason gwo sel and everyone else ordered fries and salad, but my meal came 3 hours before anyone else's."

This is Stuart/Stu/StuLu/Stubaby. She is not technically part of the staff, but she is a long-term volunteer who has become part of the family.

Hometown: Virginia Beach, Virginia. Yes, she wears Tory Burch rubber flip flops.
How she got to MFH: Her high school, Norfolk Academy, has an amazing program for high schoolers interested in global health, called the Global Health Fellows. She has spent the past four years designing and piloting a Women's Empowerment Curriculum for adolescent women.
Superpower: Answering really uncomfortable questions about sex and male anatomy from the girls who attend her class. I don't think she can do it with a straight face, though.
Quote: "Ina May just gets prettier and prettier every time I see her" (not kidding, Ina May is taking over the world).
Job: Again, she is not MFH staff, but she's been here for over a month now co-teaching her curriculum in Rivage and at the girls' orphanage...and we love her like a sister.
Fun fact: Her family owns Smithfield meats and her brother once threw the party of the century without her parents' consent (think Project X without the house burning down).
Favorite MFH memory: "Whoosh Papi!"


This is Ina May. Ina May is the house cat, and she is named after Ina May Gaskin, a famous midwife.

Hometown: Hinche, of course!
How she got to MFH: As I recall Nadene tells it, she was looking for a house cat to get rid of the mice, and saw some kittens by the side of the road in Cange. She asked if she could have one, but they were all claimed, so someone called someone who knew someone whose sister had cats to give away. I imagine Ina May was the prettiest and most standoffish one, so she was the perfect choice.
Superpower: Controlling humans with her love-hate demeanor.
Quote: "Meow meow meow," when she is particularly in need of attention.
Job: She is paid in cat food and non-consensual snuggles for her mouse-catching skills and general cuteness.
Fun fact: One time, Ina May got so fat we thought she had a tumor and was going to die. We gave her an ultrasound and it turned out that she had SIX kittens in her very large belly. Also, she won't tell you this, but I am her favorite human.
Favorite MFH memory: When Carrie started combing her with her comb (we presume).

Lastly, this is me, the eccentric author of this blog. I spent a year with MFH from 2013-2014, left for a year for grad school, and am back working on data collection for seven weeks. I still speak in the present tense, as if I am still an employee of MFH.

Hometown: Technically, my parents live in Ebensburg, Pennsylvania (Pennsyltucky, if you will). But currently, my home is in Boston, Massachusetts.
How I got to MFH: A college friend, who was a year ahead of me, told me about his post-grad plans to spend a year in Haiti working at a rural clinic. When I discovered, months later, that I'd missed the deadline to apply for his fellowship, he directed me to MFH, where his friend was working. I emailed Nadene, and was already planning a trip to a nearby village in January of 2013. On that trip, I was able to visit the house to meet everyone...and the rest is history.
Superpower: Salsa dancing like a Haitian woman (or so I am told :))
Quote: <insert obnoxious request directed at Ina May>
Job: Again, not an employee anymore. I'm just an MPH student who is obsessed with everyone in this organization.
Fun fact: I could eat brown rice, beans, and beet salad every day for the rest of my life.
Favorite MFH memory: "Jenna's birthday party last year, when we set up candles and yoga mats on the porch and played music all evening."

Revamping Data Collection!

Now that I'm into the second week of my practicum, I'm getting a much better sense of how things are going to be during the seven weeks I am here. Last night, I felt like I hit a bit of a brick wall, but after talking to Nadene and Steve this morning, I feel much more confident that I'll have a lasting impact here at MFH.

I have been planning this practicum formally since December 2014, and informally since I found out that my degree program required a practicum. Midwives For Haiti was the obvious choice, because I already have in-depth knowledge of the ins-and-outs of the programs, I am already well-known by the Haitian and American staff, and I am fluent in all three languages I could possibly need to complete the job.

I began conversations with Leona, the past In-Country Director, in January or so about a specific project. All MFH staff seemed to be in agreement that data collection needed some major TLC, and that my skills would be best used if focused towards data collection. Mobile clinic was the priority, but connecting mobile prenatal clinic patient data to hospital birth data (i.e. following a patient who had received prenatal care and then delivered at the hospital to determine their outcome and that of their infant) was also needed. I created a plan for my work down here: begin the foundations for a formal monitoring and evaluation plan for mobile clinic; revamp the data collection process; troubleshoot.

Despite working on limited battery power, I got a really solid start last week when I was able to develop first drafts of a logic model and a monitoring plan. The logic model lists the inputs (e.g. staff, financial resources, equipment), outputs (i.e. activities, such as prenatal care and STI testing; and participation, such as the women we reach and SBA students who train there), and outcomes (long- and medium-term goals, which ultimately lead to our final goals: reductions in maternal and infant mortality. Mapping things out in this way allow us to reflect on the changes we hope to lead to those reductions in mortality. The model also can be incredibly useful in determining how we, as an organization, will evaluate if we have achieved those intermediate and final outcomes.

The monitoring plan is primarily to ensure that what we intend to happen is actually happening. For example, we want every new mobile clinic patient to be tested for gonorrhea and chlamydia. But, these tests must be done in a private area since they require a speculum exam. If the table breaks, or the facility is not private, or the test kits do not arrive on time, we are not able to perform the tests. Or, we want to make sure we are arriving at every clinic each month. This cannot possibly happen because sometimes the vehicle breaks down, the river is too high, or it is a holiday. In-country staff knows when things like this happen, but keeping track of them using a monitoring plan can help ensure that problems are recognized and can provide evidence for follow-up. From the monitoring plan sprung a simple checklist that can be filled out by a MFH volunteer or staff member (with the help of a translator) at a clinic. Emily, Stephanie and I worked together to determine when and how often monitoring would take place. Here is part of the first draft of the checklist:

I imagine that developing the logic model and monitoring plan will be an iterative process, but my next steps with mobile clinic are to work on the physical data collection sheets and the indicators we are looking for. Currently, there are a couple of different methods being used for diagnostics and for data collection. As much as possible, we need to merge the two! Steve and I did some brainstorming and I'm excited to begin working on a draft in the next few weeks.


I'm also going to be looking at data collection at the hospital. Hospital Ste Thérèse is an interesting place, and our role there is always a bit unclear to me. It is an MSPP (Ministère de la Santé Publique et de la Population; AKA the Ministry of Health) hospital, so all paperwork is done the MSPP way. We have access to their data, but the only readily available data is the few indicators we select from the birth log each month. The birth log, la registre de maternité, is literally a massive paper-back book whose cover is held on by bandaids. Every patient gets one long row that spans two pages, where their demographic information and basic information about their delivery gets recorded. Individual patients have patient records which are archived swiftly after the mother leaves the hospital. Apparently the archives room is a ridiculous labyrinth and I hope to never have to venture inside to find patient information. THAT is why electronic medical records are so necessary. Long story short, Midwives For Haiti cannot access patient information unless we locate and go through every individual patient chart ourselves. The organization simply does not have the manpower for that. So, the postnatal midwives, who see almost 100% of the patients who deliver at Ste Thérèse, have been enlisted to fill out simple, MFH-designed data sheets so that we can find out who received prenatal care from our mobile clinic, who was referred to the hospital by the mobile clinic, who had complications, and who was properly treated for those complications, etc. There is a system in place to compensate the midwives for completing the sheets, collect the sheets, enter the data, and I hope to help create a plan for data analysis. Phew!

Before...

Midwives For Haiti has also begun a really exciting new project: a birth center in a town called Cabestor. Last week, it was appropriately painted a light shade of pink (check out the before and after below!), but soon we'll be getting into the nitty gritty details of how to really get this place going. MFH has wanted to open a birth center for a long time, and now that we are finally on our way, we want to make sure we're doing it right. The rest of the programs (the SBA training, mobile clinic, etc.) started so humbly that we don't really have solid baseline data on which to base any evaluation. However, in Cabestor, a relatively small town, we have the chance to formally evaluate the change a rural birth center would make for the community. Part of my job is now to look at the baseline data that has been taken, the surveys that will be used to re-assess the state of maternal health this coming December. I hope to work with Steve and Dr. Tom (a physician who knows Cabestor well and will be helping MFH along the way) to ensure that valid data is collected using best practice.

...after!

Lastly, I'll be working with Stephanie on MFH's strategic plan for 2015, as well as a way to log our progress and a system for checking in to be sure all staff have the goals and objectives in mind. Phew!


I should mention that a wrench has been thrown into the mix. In the last week, we learned of three individuals who have stayed at the MFH house in the last month and tested positive for Dengue fever. A few staff members have had fevers and body aches, but we are not sure if there is a mini-outbreak. Emily is fully convinced that Chikungunya morphed into a milder version of itself after everyone in Haiti became immune after infection last year. Frankly, any outbreak of Dengue would have to be very widespread for the infectious disease community to take notice, so I'm really just hanging out, using bug spray, and hoping for the best. I'll keep you updated here!