Reflection at the Citadel

Our guest blogger this week is Sarah Curley, Nurse Educator for MFK.

Dr Pat and I hiked up the Citadel the other day. As I slowly plodded one foot in front of the other this woman hiking alongside me seriously humbled me. Her energy is unmatched by anyone I’ve ever met. 75 minutes of twisting up the mountainside to reach the historical fortress was tough work. Especially at 31 Celsius and unrelenting sun. This venture is a drop in the bucket compared to the reality of transportation nearly all my patients experiencing to get to basic health care services, such as the malnutrition program we offer at local clinics here in Cap-Haitien.

The way of life here in Haiti is hard. Everyday I see patients that walk hours and hours to get to clinic. Coming to seek information, treatment, and help. They walk in flip-flops, or old shoes that don’t fit quite right, and sometimes barefoot. Crossing rivers, traversing valleys, and ascending mountains just to come down again.

There are motorcycles everywhere, but if you earn less than 2 dollars a day as most Haitians do, eating and transprotation becomes a choice. Going to the city for a weekend often means exchanging weekend meals for a motorcycle ride. I’ve met women who told me they walk 13 hours every Friday to get to market, exchange goods, then walk 13 hours home the following Monday. 26 hours of walking with 30 pounds or more of goods propped perfectly on top their heads.

One patient in particular that really found a place in my heart walked with her 18-month-old daughter for two and a half hours to get to clinic. Her daughter was having trouble breathing because she was so weak from malnutrition. We took her to the hospital and they were able to treat the pneumonia but unfortunately because her heart had been working so hard since her birth she didn’t survive. Before she died, I had the opportunity to trek into the mountains with her mother to their home. It is not safe for me to go all the way so I waited with a group of her community friends by the river until she returned. My feet were aching and I had my best shoes on, she was wearing flip flops. Silianna’s death was devastating for the nutrition department at MFK. Being in Haiti has taught me how to grieve on a higher level than I’ve ever experienced before. How necessary it is to say goodbye to what has been lost, and carry on living with what you do have. We all have a choice about what we hold on to and what we let go of. I could let her death make me want to go back to the country I was born in where I have access to life saving and preventative medicine. So I would never have to experience watching a child die a preventable death again. Or, I could pick up my feet like her mother did, walk back across the river and up the mountain to bring rice home to her two other hungry children.

The biggest challenge for treating these patients is transportation. Access. The pockets of malnutrition in Haiti are the worst in the most rural settings. This means driving hours and hours at a time to get to our program sites. No only do we drive the hours to get to the site, the patients have to walk hours as well. The roads are not maintained, sometimes there aren’t even roads. We just find space between the trees big enough for the truck to pass through. I’ve spend many moments pacing the bank of a river to find the highest point where the truck can cross. I have added driving four-wheel to my resume because even though I am just a nurse, health care is more than just direct patient care. It’s about finding solutions to the problems about access. Making what is most needed available to those that need it.

Standing beside Dr. Pat the peak of Citadel I could sense some deep reflection on both our minds.

The first time I looked down at Cap-Haitien from this standpoint was 8 months ago and I felt curious. I had just arrived in Cap-Haitien. I had no idea what to expect.

However yesterday, I looked at the city with details and memories.

I thought of Siliana and said goodbye. I saw the short cuts in town we use to bypass the traffic jams. I saw our clinic in Shada, in what can be described as the slum of Cap Haitian. I smelled the burning garbage that constantly fills the air beside our clinic. I saw my neighbor’s garden, filled with weeds and corn and basil, with a mango tree oddly reaching over the fence. The unrelenting dogs barking, honking horns, and generators running. Each zone seemed to have a face of the malnourished children we treat pop up in my mind. I see Cap-Haitien as home now, I have routines to get through the week. I have friends and neighbors.

I’ve had many long journeys and I’ve only been here 8 months. As Dr. Pat approaches 30 years of practice as a physician in Haiti, I wondered what roads she has traversed and what memories flashed across her mind when she looked down on Cap-Haitien.